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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“Sir, having the correct diagnosis and the choicest management for each illness not only results in better outcome but also saves us money. Referral to the correct doctor and discipline for treatment is essential for reduction in hospital admissions. Sir, many Singaporeans are concerned about rising medical costs, and this is especially so for the elderly folk in our midst who have no income but increasing medical needs. In time to come, this increasing burden will affect even more people due to our fast ageing population. I would, therefore, like to urge MOH to have good plans, insurance schemes and various safety nets put in place to ensure affordable long-term healthcare for all Singaporeans.”
“Sir, one of the biggest challenges for MOH now is to ensure that healthcare for the elderly will be efficient and affordable in the years ahead. We should be proactive in planning the financing of elderly care, promoting healthy lifestyles amongst our elderly, enhancing preventive healthcare and catering to the various imminent healthcare needs of the elderly. We must start laying the foundations for eldercare with urgency and ensure success in this area. I hope that MOH will be proactive in implementing appropriate measures in this area soonest. 1.00 pm Elderly healthcare has to rely on the existing culture of self-reliance and taking personal responsibility and the premise that early preventive measures are preferable and more effective than later interventions at points of crises. I hope MOH can implement more aggressive measures in assisting our elderly lead healthy lifestyles and providing more preventive care for our elderly. An important message for this group will be "disabilities in old age are often due to disease and early treatment of the disease can prevent disabilities." Upon this basis, it is necessary for MOH to ensure that those with diagnosed chronic diseases can get their regular long-term medications. It is, thus, necessary to include chronic diseases care, which is presently not provided for those eligible poor elderly in the Primary Care Partnership Scheme. I would like to declare, Sir, that I am a doctor looking after some patients under PCPS. A one-stop diagnosis and care-plan centre is essential for elderly care. At this centre, a standardised and holistic assessment can be done according to the patient's needs.”
“It will be ideal if more follow-up and reminder facilities are available to keep track of those who have defaulted on treatment or who have neglected check-ups, especially for chronic diseases. The other two areas worth emphasising by the Health Promotion Board are in stroke prevention in order to reduce the number of patients with long-term disability and in raising the awareness of increased risk of late pregnancies in view of our low birth rates. Healthy Lifestyle”
“Sir, my cut is on preventive healthcare. I would beseech that MOH prioritises to maintain our elderly population as fit and healthy for as long as possible. In this regard, I believe in promoting healthy lifestyle amongst our elderly population more aggressively, targeting especially the retirees and housewives. Would MOH proactively strive to keep our elderly physically, mentally and socially fit and thereby postponing or retarding functional deterioration? This is especially relevant for retirees and housewives who are otherwise too sedentary and home-bound in their retirement. This inactivity and seclusion are definitely not healthy and they are therefore more prone to physical and mental health deterioration. This preventive healthcare can be promoted through purposeful centres for such programmes in the community where they live, such as in the nearby community centres. I have had success in my constituency with five centres in the last six years, and I hope to see more in other constituencies to cope with the increasing demands of our changing population. Would MOH encourage and facilitate community bodies such as grassroots organisations, VWOs, private organisations and CDCs to set up and run these centres? Such centres can evolve in time to help the frail and semi-dependent elderly live in the community for as long as possible and not depend on institutional care. Sir, preventive care should remain the hallmark of eldercare. MOH should facilitate further in this area with more campaigns through the doctors and healthcare workers, the grassroots organisations and VWOs as well as the media to encourage Singaporeans to go for early health checks and treatment.”
“(7) It is worthwhile to include the extension of the service hub to become a training hub as this will boost our aim of being a medical hub in the region. This will have the effect of promoting collaboration with doctors in the neighbouring countries and of gaining their acceptance of us. (8) Innovative packaging with other products such as insurance, travel arrangements, hotel and shopping needs should be facilitated to make it more attractive for consumers to come here.”
“Sir, may I ask the Minister for Health on his plans to enable Singapore to become the regional medical hub? May I ask the Minister to quickly activate measures before we lose the chance completely as our neighbouring countries have been making up grounds in healthcare services by leaps and bounds? These countries have the advantage of lower cost and the marked difference in cost is driving large numbers of cost-conscious patients from the region away from Singapore. In our endeavour to succeed in this area, may I ask the Minister to consider the following points: (1) Facilitate a more competitive cost of healthcare to attract foreign patients. (2) Ensure that healthcare for Singaporeans is not affected by having foreign patients, which he assured us earlier. (3) There is a need to integrate our healthcare clusters and sectors for better economies of scale and maximising our limited resources to compete globally and not competing between ourselves. (4) Singapore has a very good reputation as a centre of medical excellence and our healthcare professionals are recognised for their high quality and efficiency. We need to have a more structured aggressive marketing of this fact. (5) In order to have the upper edge, there is a need for innovation and we need to develop an ability to predict future trends. (6) To maintain Singapore's medical excellence, there is a need to pay more attention to the training of our future generation of healthcare providers. Only by continuing to invest heavily on our undergraduate and post-graduate medical education will we ensure that our doctors are competent and conversant with the new developments in medical sciences.”
“Another consideration is on our pro-natalist importance where couples are insured for procreation anomalies such as complicated pregnancies, premature babies and infertility. Two important areas to ensure success of such "risk pooling" policy are, firstly, universal coverage to involve the whole population and, secondly, on the provider payment side, reimbursement should be according to a nationally uniform fee schedule.”
“Sir, may I beseech the MOH to look into healthcare financing in Singapore to ease the pain of healthcare expense? As I have said before in this House, the present Medisave system where we save and pay as we go financing for healthcare is becoming less adequate to serve our needs. By retirement stage, healthcare costs are expected to be higher. We need to make drastic changes here now for a better tomorrow. Savings alone for healthcare financing is not ideal anymore and may cost too much for each individual to bear, especially when meeting critical and severe diseases that may wipe out all the savings in no time. Sir, "Risk Pooling in Healthcare Finance" is a good consideration. "Risk pooling" is required because of the large uncertainty in the magnitude and timing of an individual's healthcare expenditure needs. It implies the redistributive functions, from the healthy to the sick and from the productive to the unproductive stage of the life cycle. The arguments in favour of "risk pooling" in healthcare reflect equity and efficiency considerations. Fear of over-consumption can be minimised by adopting best practices. MOH needs to assume this role of "stewardship" of healthcare financing urgently to cater for rising health expenditure, demographic change of an ageing society and technical innovation. In our health insurance expansion planning, some incentives should be incorporated to rally Singaporeans towards keeping fit and healthy. The other issue in the health insurance expansion is to ensure coverage for Singaporeans when they are in dire need, such as when they are without jobs and between jobs.”
“Presently, the “C” class wards are already bursting at the seams. How does MOH ensure that the most in need are not going to be deprived of such high demand subsidised beds and care in public hospitals? Will there be more allocation of subsidies for public hospitals?Under the present allocation of subsidies, together with an increasing number of hospital admissions, I am afraid that the imbalance of subsidies and operating costs will be passed on to patients. Will there be an increasing and good provision for our national healthcare to prevent the imbalance? Is there a better plan on how healthcare subsidies will be distributed?”
“Madam, DPM Lee said in his Budget Statement that, even with means testing, a high income patient can opt for B2 or C class treatment but will be subsidised less. The concern is that there are people in the sandwiched group that do need the heavier subsidy due to financial constraints or heavier commitments. Considerations must, therefore, be accorded to this group who need the heavier subsidy, not by choice but by circumstance. Will MOH ensure healthcare affordability for the majority before implementing means testing? We should establish some alternative risk sharing insurance for our population before implementing means testing. To this end, healthcare financing through insurance to reduce an individual's burden at the time of need is a worthy consideration. As I have mentioned before in this House, national insurance covering the whole population through our Medisave should be allowed. 6.15 pm At present, means testing in nursing homes is based on the total income of older family members divided by the number of members in the family. Madam, this is unfavourable to small families. Often times, it is difficult to get information on income from all the members of the family and many elderly fail to get a subsidy as a result. Other times, family members or applicants are not willing or unable to submit their documents for a variety of reasons as with confidentiality or self-employment situations. There is a need to refine the present system of means testing. Madam, it is inevitable that with our ageing population, an increasing number of people will need more subsidised hospital beds. Is there a plan to increase the number of “C” and “B2” class beds together with the necessary medical teams for them?”
“May I ask the Minister to monitor and ensure that more efforts are made by public hospitals to work closely with one another to avoid duplication of services, to merge similar services and to review and share best practices, rather than competing for the same limited resource, especially human resource? May I also ask the Minister, lastly, when will he implement a system in our public hospitals to integrate information for better patient care and to avoid duplication of investigations and treatment? Are more efforts being made to better inform the public on each hospital's facilities and to better manage the expectation of the people on public healthcare?”
“Sir, I beg to move, That the total sum to be allocated for Head O of the Main Estimates be reduced by $100. Madam, it is inevitable that with our ageing population, our healthcare costs can only go up. Will our Government prioritise adequate allocation for healthcare? Presently, our Government spends about 1% of GDP on healthcare. Is there a plan to allocate an increasing amount on the healthcare expenditure, and by how much each year, to cope with the increasing needs? The Minister for Health has said that managing medical inflation is one of his Ministry's priorities. I would, therefore, like MOH to consider the following three tenets that are important for our healthcare cost restraint. Firstly, prevention is better than cure; secondly, healthcare gets more costly, progressing from primary to tertiary care; and, thirdly, healthcare should be commensurate with expertise. On the first tenet, as I know that the Minister for Health is an advocate of disease prevention, may I therefore ask MOH whether the budget of $98 million for the Health Promotion Board for FY 2004 pales in comparison to $2.06 billion of MOH's total expenditure? On the second tenet, in order to reduce the dependence on the use of tertiary care, is the Minister providing more intermediate care facilities that are presently inadequate, especially in view of our ageing society? On the third tenet, may I ask whether MOH is reviewing practices in our public hospitals to avoid incentives for over-servicing, especially in specialist services? May I suggest that MOH put in place an appraisal system to take into consideration efficiency without compromising on patient care and ethics? The Minister has also commented on the silly competition between public hospitals.”
“Madam, Iwould object that the Minister of State put words into my mouth. That was not what I meant. I just said that I would like to see more to be done. I beg leave to withdraw my amendment. Amendment, by leave, withdrawn. People's Association”
“I appreciate that the Minister of State agreed with me,but I would like to see more action being done. The Minister of State did not answer my question on the possible credible websites that young people can acquaint with each other. Could he please make some comments on that?”
“Work-Life My next topic is on work-life. Our Government has set up a Work-Life Unit under the MCDS to promote family-friendly practices among employers. Are there any targets set out for this Unit? Should there be an increase in efforts in terms of tangible incentives, such as grants and tax relief for companies to adopt family-friendly practices for their employees? Some employers expect their employees to attach greater priority to the company and demand that their employees spend as much time as needed at work even beyond office hours. Complaints have been heard that employers are not happy when their employees take time off for family and personal needs. Would MCDS redouble its efforts to do a lot more in facilitating family-friendly working environment? Young people in Singapore have been heard to lament on the job demands and the lack of time. One in three Singapore adults in their early 30s is still single. Trend researchers have found that modern lifestyle and job demands are killing traditional courtship. One in five single British men and women is turning to dating agencies and personal advertisements to start relationships. Credible websites run by Government agencies or reputable private organisations that ensure correct and certified data of individuals will be useful. I believe that in the IT era, this channel will prove to be the preferred choice for many IT savvy and busy young people to acquaint and befriend each other. Would MCDS look into more of such websites?”
“Madam, I beg to move, That the sum to be allocated for Head I of the Main Estimates be reduced by $10 in respect of Code IG 1500. Madam, there is a need to inspire more people, especially the young, with a deeper sense of individual responsibility towards the family. Presently, the trend in Singapore is towards smaller and smaller families; extended families will not be the norm soon. And since the majority of Singaporeans are all working, many will become too busy for interaction with families and friends. Such a trend is bad and must be addressed. Strengthening family ties, better bonding with extended families and neighbourliness are areas worth cultivating. Community-based organisations should organise more activities in grassroots programmes to promote these virtues. Our CCCs, CCMCs, CDCs and Town Councils can be active partners too. Would MCDS promote and facilitate such family bonding? Basic social etiquette and interpersonal skills should be taught and promoted. This will lead to our young being better equipped with skills in handling boy-girl relationship, marriage and parental responsibility, and so on. Such "values" transmission can be done through teachers in schools, through parent-school-community partnerships, through religious and community groups, and through the media. Would MCDS promote such "values" transmission? Facilitating and providing avenues for young people to come together in the schools, polytechnics, universities and community centres, and so on, will give them the opportunity to intermingle with peers within their cohorts. This opportunity may not be there once they start working life. MCDS could facilitate more grassroots organisations to organise the various activities in the respective constituencies to provide such avenues.”
“More effort should be spent in this area, perhaps through campaigning and promoting a change in the stereo mindset of many men regarding parenting and household responsibility, and to be equal partners in raising families. Value of Children Assoc. Prof. Ngiam Tee Liang: Sir, I am concerned about some of the feedback given by members of the public recently when asked to comment on the new proposed measures to boost our fertility rate. Some of these views seem to suggest a preoccupation with the material benefits rather than the intangibles, such as the values and attitudes of having children. In this connection, Sir, I would like to ask the Minister if there is going to be a balanced emphasis in the various proposed measures, that we actually emphasise the value of having children and not so much just the fiscal rewards that we will get from the Government's proposed measures.”
“Sir, there is a need for a change of the attitude of parenting towards "Happy Parenting". There had been too many negative reports and negative emphasis of parenthood. We need to start an aggressive campaign to correct this negative mindset. The emphasis on such campaigning should be on the joy that family brings. There is a general tendency for the younger people in our workforce to put off courtship, marriage and childbearing to very much later on in their lives. Parents and young people should abandon the mindset that students should not court until they have graduated and are established in their careers because, by then, it becomes increasingly difficult to interact and to start courting. Young people would be well advised to be responsible adults who are accountable in their relationship, responsible towards others, and sensible in pursuing studies simultaneously with a relationship without jeopardising one or the other. In Singapore, women assume the main responsibility of housework and childcare, regardless of whether they are employed. Working women are often stressed from the multiple responsibilities. Research into marital satisfaction among Singaporean women showed a direct correlation between stress levels in women and the amount of help they get at home. Traditionally, the father had been the sole breadwinner and the distant disciplinarian while the mother had been the nurturer and homemaker. In the present dual-income family, there should be a shift away from this perception of the roles of fathers and mothers. Parenting and homemaker tasks should be shared between spouses.”
“This benefits both the parents as well as the nannies. The scheme could be administered jointly by MCDS and grassroots organisations whose members have personal knowledge of their families in any particular precinct. However, I would like to ask that the prospective caregivers be interviewed, their homes be inspected, and it be made compulsory for all potential caregivers to attend a properly conducted course on infant and childcare to ensure that they are well qualified for the task. As an additional step, some kind of registry of nannies should be kept by, say, the CDCs and any misdemeanour reported would count against the registration. This would also help to give assurance to parents who entrust their infants to these nannies. Currently, many childcare centres only open till 6.00 pm. I would like to ask the Minister to encourage more centres to open till later as many parents have to rush home from work to fetch their children. Additional subsidy could, for instance, be given to child/infant care centres that extend their operating hours.”
“This, in effect, calls for employers to consider providing childcare centres at the workplace. In this respect, I hope more generous grants can be given to companies to set up childcare centres at workplaces. The present $26,000 is too small an amount for set-up costs, especially for those providing childcare centres in accordance with MCDS guidelines. Dr Amy Khor Lean Suan (Hong Kah): Sir, the Government's recent announcement that it will add another 3,000 infant care places in the next five years, representing a 10-fold increase over the present number of places available, as well as initiatives like the home-based nanny matching services, are indeed welcomed. Presumably to accommodate the additional places, the number of infant care centres will also be increased. I would like to urge the Ministry to not only look into the setting up of infant care centres in residential areas but also encourage the setting up of child and infant care centres in areas with high concentration of workers, such as in the CBD, business parks and non-pollutive light industrial areas. This would make these centres more accessible to working mothers and, as gender roles harmonise even further, fathers as well could also visit their children over their lunch breaks. MCDS could work with MND to give developers and building owners incentives to set aside space for such use, for instance, by excluding such space from the gross floor area computation up to a pre-determined amount. Further, the subsidy, particularly for infant care, should be raised as the cost of infant care can be up to $1,000 or even more per infant. Also, I would like to urge the Minister to aggressively promote the home-based nanny matching service which appears to have been very well received.”
“Sir, childcare concerns are a top worry for many couples. Working parents need more support in childcare arrangements. There are less than 24 childcare facilities that offer infant care for babies younger than 18 months. May I ask the Minister on the progress of such childcare centres? Could the Minister encourage more efforts in setting up such centres to expedite their availability to working mothers who cannot find other alternatives in childcare? Could the Minister also pay heed to the psychological aspect of such young children in these centres, such as the necessity for a constant mother-figure to prevent distressed children and other developmental problems and for periodic checks by child psychologists? Presently, fees at such centres are about $700 to $1,200 per month. These fees are beyond the affordability of many working parents. In view of our declining TFR, we should try to improve on childcare facilities, making them conveniently available and subsidising fees at 75%. The ideal caregivers for infants are, of course, the parents themselves. However, in the context of Singapore, immediate family members, relatives, neighbours and even friends can be reasonably good parent-substitutes. Therefore, childcare incentives should also be extended to grandparents, nannies and relatives who are supervised and certified by MCDS. This will give working couples the choice of homecare for their children and will provide the elderly or housewives with some income while they stay home. Better childcare centres staffed with certified professionals and dedicated caregivers will give peace of mind to parents who now want professional care for their children. There should be more childcare centres conveniently located in relation to either the home or the workplace.”
“I would like to suggest that now we should have a replacement of such leave as one-week procreation leave borne by the Government to facilitate expecting mothers to attend antenatal check-ups in the early stages of pregnancy and to allow infertile couples to seek treatment. Mr Deputy Speaker, Sir, in the past, we often heard our Government asking our people to bite the bullet and take the painful measures. Today, in conclusion, I call on our Government to respond and take the bitter fiscal measures to save our nation.”
“Our CDCs, CCCs, CCMCs, RCs and Town Councils should actively promote and support more of such activities. Medical Lastly, I would like to touch on the medical aspects of procreation. In Singapore, one in five women has kids when she is 35 years old or older. Sir, this figure far exceeds the developed world average. Pregnancy in older women carries increased risks for mums and babes; these include miscarriages, pregnancy complications and complicated deliveries. Publicity and promotion of earlier childbearing age should be done extensively to educate the public on the medical disadvantages of pregnancies in older women. MOH can promote this message through the Health Promotion Board or in collaboration with other organisations. I have suggested for more risk-pooling insurance schemes for medical expenses, and maternity insurance should be provided for from our Medisave to insure couples for complications of pregnancies, childbirths and premature babies that can incur financial burdens to young couples. The prevalence of infertility in Singapore is high. One in five married couples finds it difficult to conceive. More should be done to help these couples in their dilemma. We should re-look ways of assisting and increasing fertility success such as in the funding of existing non-profitable fertility enhancement centres and the funding of sperm and ova banks. The Medisave withdrawal for in-vitro fertilisation (IVF) should not be capped anymore and we should allow the use of Medisave for up to at least three treatment cycles and facilitate infertile couples to afford the expensive treatment. Sir, in 1987, the one-week sterilisation paid-leave was removed.”
“This opportunity may not be there once they start their working life. There is a general tendency for the younger people in our workforce to put off courtship, marriage and childbearing to very much later on in their lives. Mr Deputy Speaker, Sir, parents and young people should abandon the mindset that students should not court until they have graduated and are established in their careers because by then it becomes increasingly difficult to interact and to start courting. Young people would be well advised to be responsible adults who are accountable in relationship, responsible towards others and sensible in pursuing studies simultaneously with a relationship without jeopardising one or the other. It has been noted that one in five single British men and women is turning to dating agencies and personal advertisements to start relationship; confirming a trend researchers have found that modern lifestyle and job demands are killing traditional courtship. Sir, credible web-sites run by our Government agencies or reputable private organisations that ensure correct and certified data of individuals will be useful. I believe that, in the IT era, this channel will prove to be the preferred choice for many of our IT savvy and busy young people to acquaint and befriend each other. As the trend is for Singapore families to get smaller, extended families will not be the norm soon. And, since they are all working, many will become too busy for interaction with families and friends. Such a trend, Sir, is bad and must be addressed. Strengthening family ties, better bonding with extended families and neighbourliness are areas worth cultivating. Community-based organisations should organise more activities in grassroots programmes to promote these virtues.”
“Our Government can promote this mindset by increasing the paternity leave from three days to 10 days with full pay borne by the State in order not to burden companies. This will send a strong signal that men are responsible too for the care and upbringing of a child. More effort in this area will be useful, such as giving further incentives for companies and having a campaign to change the stereotyped mindset of many men regarding their roles in parenting and household responsibilities, and the need for them to be equal partners in raising families. Sir, a good marriage needs time and commitment to nurture and sustain and can be very time-intensive. Unfortunately, employees lack time due to the demands from work. Therefore, family-oriented working environment will help employees, especially for young couples. A campaign on family-friendly practices to be adopted by companies as good investments with profitable returns should be stepped up. Sir, there is a need to inspire the young with a deeper sense of individual responsibility towards the family. Basic social etiquette and interpersonal skills should be taught and promoted. This will lead to our young being better equipped with skills in handling boy-girl relationship, marriage, parental responsibility, and so on. Such "values" transmission can be done through teachers in schools, through a parent-school-community partnership, through religious and community groups and through the media. Facilitating and providing avenues for young people to come together in the schools, polytechnics, universities, workplaces, community centres and so on will give them the opportunity to intermingle with peers within their cohorts. Government should provide funding and incentives to facilitate this avenue for young people.”
“The Government must also show the example by not just selecting and promoting people in the civil service with the highest academic qualifications alone, but also with other and different criteria. Mindset change There is a need for a change of attitude in parenting towards "Happy Parenting". There had been too many negative reports and negative emphases on parenthood. We need to start an aggressive campaign to correct this negative mindset. I remember the publicity on "Stop at Two" campaign in the past, which was so intensely carried out that I was bombarded with that message every single day. Sir, that had left an imprint in my brain till today and I can still see that message in my head. Now, aggressive affirmative publicity should be on happy parenthood. The emphasis on campaigning should be on the joy that family brings such as the great feeling to hear the little ones saying "Mum", "Dad" and "I love you", and the happiness the first time you hold your newborns. The slogan, Sir, could be, "The more in the family to share your life with, the merrier it is". In Singapore, women assume the main responsibility of housework and childcare, regardless whether they are employed. Working women are often stressed from the multiple responsibilities. Research into marital satisfaction among Singaporean women showed a direct correlation between stress levels in women and the amount of help they get at home. Traditionally, the father had been the sole breadwinner and the distant disciplinarian while the mother was the nurturer and homemaker. In the present dual-income family, there should be a shift towards this perception of the roles of fathers and mothers. Parenting and homemaker tasks should be shared between spouses.”
“This will save parents 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, especially our primary 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 times. Thus, ranking should take attainments in developing the potential of students in information technology, sports and the arts into consideration. Schools should be ranked by bands, rather than individually. Sir, the lessened emphasis on how individual schools fared on the O-level results just recently is welcome indeed, and I hope MOE will further ease individual school ranking. Having flexibility in school and university entry criteria, such as considering the non-academic ability, will lessen the stress from many students and parents. Parents can then be more relaxed to allow their children develop their own unique potential though it may not conform to the norm. Universities should not be too fixated on accepting students with a string of straight A's and there should be more flexibility and some open-mindedness in student admission. The Second Language ruling for varsity and independent criteria for university acceptance announced recently were commendable and a good start, and I hope to see more favourable criteria expanded. Sir, we do have to convince Singaporeans that success does not come from just highest academic achievements alone. There must be more definitions of success. For instance, one can be considered a success also from being well-trained and qualified in the vocations.”
“Sir, Singaporean parents have also frequently mentioned children's education as the contributory factor in opting for smaller families. A study in 1999 on pupils' stress showed that pupils' stress in terms of overload had increased since 1990. The Ministry of Education should strive for a less stressful education while developing a child's potential. I think it is time that our Ministry of Education reviewed and effected some changes. Primary education streaming should be scrapped to reduce the stress for pupils and parents for primary level. This will also address the fact that there are late developers that may be disadvantaged from early streaming. Principals must ensure that teachers do not overload pupils with homework and tests. More emphasis should be given to better teaching resources to make education in schools interesting. Better parent-teacher rapport and feedback are needed to monitor pupils' progress and family stress from education. There is also the need to provide teacher-counsellors and professional counsellors. There must be guidance on supportive parenting and the prevention of parents pushing their children to achieve beyond their ability and to avoid parents' stress. Sir, many parents turn to private tuition for their children. It will be a good idea if our schools provide tutorial classes after normal school hours, not for 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, ballet, and so on, collectively, after classes in the schools.”
“The experiences of family-friendly firms in the US have been that they reap productivity gains, better customer service, higher staff retention rates, reduction in recruitment and training costs and a drop in absenteeism. Although our Government has set up a Work-Life Unit under the MCDS to promote family-friendly practices among employers, more has to be done in terms of tangible incentives such as grants and tax incentives for companies to adopt family-friendly policies for their employees. Sir, many employers expect their employees to attach greater priority to the company and demand that their employees spend as much time as needed at work, even beyond office hours. Complaints have been heard that employers are not happy when their employees are expecting and taking time off for antenatal check-ups and maternity leave. Presently, only 3% of the Singapore work-force is on part-time work compared to 24% in the UK, 23% in Japan and 17% in US. Less than 2% of workers have flexible work hours compared to 28% in US, 12% in the UK and 8.7% in Japan. I would like to beseech our Government to really do a lot more to facilitate flexible work option and family-friendly working environment. Presently, there is a dearth of flexibility in work arrangements especially for professionals. Teleworking has not taken off. There is also not enough assistance and training for women to re-enter employment after being away for a while. Stressful education The study by Dr Stella Quah of National University of Singapore on the Singapore Family revealed that the greatest worry for about 45% of them came from the problems associated with their children's education.”
“This, in effect, calls for employers to consider providing childcare centres at the workplace. In this respect, Sir, I hope more generous grants be given to companies to set up childcare centres at workplaces. The present $26,000 is too small an amount as set-up cost, especially for those providing childcare centres in accordance with MCDS' guidelines. Family-friendly work environment The 1990 Singapore Census showed that 40% of all married couples are dual-income earners. Many dual-income earners have difficulty in balancing work and family due to the lack of conducive working environment and this causes the 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 found 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 more 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 their commitments and stay in the workforce. Sir, the United States has never tried reshaping the birth rate or pushing any population policy, yet its fertility rate of 2.1 is the highest for the industrialised countries. The US has accommodated the need for two-earner families better in many ways than European countries.”
“Labour force incentives are as important as monetary ones to facilitate women to have children without giving up or losing their jobs. Presently, Medisave can only be used to pay for delivery and hospital charges after the third child. This should be extended to the fourth child. The present higher public hospital accouchement fees should also be removed for a third and fourth child. Childcare Sir, childcare concerns are a top worry for many couples. Especially in Singapore, children are precious to parents and they want to give them the best care and nurture. Working parents need more support in childcare arrangements. There are less than 24 childcare facilities, which offer infant care for babies younger than 18 months. More efforts have to be made in this area to rectify this anomaly quickly. In providing such centres, the infants' needs, such as the necessity of a constant mother figure, should be a consideration. Childcare incentives for working mothers should be subsidised to 75% of the fees charged by centres to give parents more options. The present subsidy of $150 is too little especially for infant care that costs $700 to $1,200 per month. Childcare incentives should also be extended to grandparents, nannies and relatives who have been supervised and certified by MCDS. Sir, this will give couples the choice of homecare for their children and will provide the elderly or housewives income while staying at home. Better childcare centres staffed with certified professionals and dedicated carers will give peace of mind to parents who now want professional care for their children. There should be more childcare centres conveniently located in relation to either the home or the workplace.”
“This should be amended to cater to couples that have to remarry for various reasons, following the demise of the spouse, for instance. Childbirth Working women find it demanding to try to balance a full-time job and motherhood. There is guilt to outsource caring of a child, especially with the newborn babies. This uneasy conscience is a phenomenon of modern parenting that makes having children daunting. Sir, it explains why extended maternity and paternity leave, prevalent in Scandinavia, seems to work. In England and many Scandinavian countries, maternity leave is six months and we should similarly extend maternity leave here in Singapore. However, as I believe our people are pragmatic and reasonable, six months would be too idealistic and an increase from the present eight weeks to at least 16 weeks would be more accountable. The extended maternity leave is especially appropriate in lieu of the scarcity of our infant care facilities and because the post-delivery period is fraught with problems and adjustments, besides being a crucial time for mother-baby bonding. In order not to burden the employers, the Government should bear all the expenses for the extra leave and this leave should be extended from first to fourth birth order. Furthermore, I would like to suggest that some, maybe four weeks, of the extra leave can be taken intermittenly, as and when required, during the neonatal period. Mr Deputy Speaker, Sir, this flexibility will certainly exemplify the spirit we want in encouraging flexible working arrangements to facilitate unexpected or urgent childcare needs at different times in the first year. Women should also be assured of their jobs after their maternity leave.”
“There is a need for extra incentives rather than disincentives for couples to go for the fourth child. Therefore, the Baby Bonus should be extended to a fourth child as well. Whatever valid reasons for not giving incentives for a fourth child should now be sacrificed for a bigger picture. Last year, our Government paid out $38 million in Baby Bonuses. Mr Deputy Speaker, Sir, even if this is doubled, it would be worthwhile for the future of Singapore. Tax rebate and tax relief 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. DPM Lee said in his Budget Statement that low birth rate problem is more serious for the mothers who are more educated and earn higher incomes. Sir, some existing incentives should therefore be further sweetened to encourage women to continue contributing to the economy for having a family. The Special Tax Rebate should be extended from the first to the fourth child starting at $20,000 for the first child to $40,000 for the fourth child. Presently, this rebate only applies to second to fourth child with a cap of $20,000 to be offset against either husband's or wife's income tax liabilities and may be claimed over five years. Taxpayers can claim child relief of $2,000 presently. This child relief should be further increased to $5,000 from first to fourth child. In formulating our procreation policy, due consideration should be given to each child born in the case of a multiple pregnancy. Sir, having twins certainly carries double the burden for a couple and they should not be disadvantaged. Also, the Special Tax Rebate is only applied to children from the same marriage.”
“In order to be successful this time, all aspects of conducive factors in raising a family should be considered in totality. Although finance is an important factor, it should be coupled with a slew of other considerations for promoting and improving the environment. This includes looking at the emotional, psychological and lifestyle choices of couples that will make any new or enhanced policy work this time. I would like to urge our Government, while retaining the old measures, to boldly implement more schemes with real impact and not as piecemeal gestures. Thus, I would like to recommend the changes in the following 28 areas. Sir, my suggestions will require a strong fiscal stomach and I do hope that our Government will see it as an investment - expensive but unavoidable. Baby Bonus Singaporeans are pragmatic people and many have expressed that raising children is costly. Finance has been considered the deterring factor, besides others, for many young couples. Sir, the Baby Bonus Scheme has not stopped falling birth rates and, therefore, there is a need for a review. I would suggest that while retaining the second tier of the Baby Bonus, the first tier payment of cash gifts of the Baby Bonus should be doubled to give it more impact, ie, from $3,000 to at least $6,000 for the second child and from $6,000 to at least $12,000 for the third child. The age at first marriage has risen for women in Singapore. The median age at which women turn mums is 30.5. One in three Singapore adults in their early 30s is still single. In line with the high age at marriage, Singapore women also begin childbearing at a relatively older age. In order to improve this trend, the Baby Bonus should be extended to a first child delivered before the age of 28.”
“(2) A recent study that polled more than 1,200 Singaporeans from housewives to professional working women of varying ages, races and educational levels, showed that the number of children they really desired was significantly higher at 2.7 children, while the women surveyed had small families with an average of 1.9 children. (3) The study on social attitudes towards the family carried out in 2001 found that 84% of Singaporeans aged 15 and above agreed that it is better to be married than to remain single while 89% agreed that married couples should have children. (4) Some northern European countries, with generous pro-family policies and Government handouts, have higher TFR. For example, Denmark has a Total Fertility Rate of 1.7, compared to most countries on the southern rim of Europe, such as Italy and Spain that have some of the lowest TFR on the continent of about 1.2. The governments of the southern countries provide much less child-related allowances than the Nordic countries. It is noteworthy that the northern countries have some of the highest fertility rates in Europe, despite the fact that the proportion of women in their labour force is also among the highest. In August 2000, Mr Deputy Speaker, Sir, PM Goh noted that it might not be possible to reverse the downward trends of marriage and birth rates, as they reflect urbanisation and changing norms, and he said and I quote, "But we must at least try to arrest the problem," stressing that, "not to try is to give up on Singapore". I am glad that DPM Lee had also said in January this year that he listed the low birth rate as one of the Government's top three priorities. I also agree with DPM Tan's call for a "total" solution to this problem.”
“Mr Deputy Speaker, Sir, DPM Lee, in his Budget Statement, said that Singapore's declining birth rate is a serious problem. Today, I would like to beseech this House to deliberate on my suggestions for specific pro-natalist schemes and to request DPM Lee to favour such incentives to improve the environment for Singaporeans to raise a family. The Total Fertility Rate, or TFR, in Singapore has reached the lowest level in 25 years at 1.26 last year. TFR has been coming down over the years and has remained below the replacement level since 1977. Sir, this trend is threatening the survival of our nation. The repercussions may be felt sooner with a lessened labour force, insufficient working population to maintain the prosperity of the country and an aging population. With our present immigration policy, such a dismal picture will reduce the resident population with consequential social implications. If this trend is not arrested, the population will start to peak in just a few decades and then Singaporeans will start dying out. While marriage and family sizes are private matters, our Government has no alternative but to try and reverse the dismal threatening trend to address the larger important societal consequences as a country. Some have expressed scepticism that no matter what Government does, it is going to be a losing battle as this trend, in today's affluent society, is already too entrenched for various reasons and therefore cannot be reversed. Sir, I beg to differ for the following reasons: (1) Singapore's procreation incentives appear to have had some effect in the early days of its introduction.”
“Thank you, Mr Speaker. Following the Minister's early mention on subsidies, may I ask the Minister on this subvention to Government hospitals? Has there been a decrease in subvention in relation to hospital admissions? Is it correct that in the years 2000 to 2003, public hospitals received less amount of subsidies but they had greater numbers of hospital admissions? Do public hospitals pass on the imbalance of subsidies and operating costs to patients, thus raising the burden for patients in healthcare expenditure?”
“May I ask the Minister on the reasons why public hospitals compete against one another for patients and market share? Has this resulted in supply-induced demand for services in our public hospitals? Are public hospitals too focused on cost recovery and is it correct for public hospitals to spend money branding themselves to attract more patients?”
“May I ask the Minister whether our present policy of encouraging competition between hospital clusters and sectors is effective in controlling healthcare cost inflation? Should there not be a review to favour more centralised control over healthcare resources for better control of healthcare patients?”
“May I ask the Minister how sure are we that the farms we import live chickens from are not affected by Avian flu? Is there a confirmation of the possible human-to-human Avian flu transmission in Vietnam involving the family cluster of 2 sisters, the brother and his wife? Are we taking enough precautions to prevent the outbreak of human Avian flu here? Could the Minister also elaborate on the contingency plan for such an eventuality? The Minister earlier mentioned that there are now 10 countries in Asia reported to have Avian flu. May I ask him whether he will advise Singaporeans travelling to such affected areas to be protected by getting vaccinated with the available vaccines and to take Tamiflu tablets? The Minister also earlier said that his Ministry is stockpiling Tamiflu. No wonder there is a short supply of Tamiflu in the market. May I request the Minister to monitor and ensure that there is enough supply of Tamiflu in the market to give to Singaporeans travelling to affected areas for preventive purposes? Is it not an important consideration to ensure that we do not get imported cases of Avian flu from Singaporeans travelling abroad, and also to prevent travelling Singaporeans coming down with Avian flu?”
“May I ask the Minister whether such a person will be the one, due to principles, who prefers the personal choice of opting in under MTERA rather than under the compulsion under HOTA? Therefore, would such a person be penalised for doing so?”
“May I seek three clarifications, Mdm Deputy Speaker? May I seek clarification on sections 9 to 13 with regard to several forms that may cause confusion and perceived discrepancy? The Minister said earlier that finality of decision is based on what is recorded in the register, and that is indeed the policy intent. May I ask the Minister why should it remain only as a policy intent? Would it not be better to make this amendment at this Second Reading to express this policy intent so as not to give rise to uncertainty or discrepancy in the future in respect of this issue of finality? Why can we not take this opportunity to have this final issue resolved once and for all? My second clarification is on section 5(2)(f) on my suggestion to also include consent to be sought from the committee of the estate, if any. The Minister replied that this is not possible as the committee is set up under the Mental Disorders and Treatment Act. My question to the Minister is whether the reason why a committee is appointed, instead of the parent or guardian, clearly indicates that the committee is in a better position to make the decision. If it is the intent under the Mental Disorders and Treatment Act that the committee be in charge of the affairs of that person, surely the intent ought to be applicable under HOTA. May I also ask, since the courts are of the view that the committee is a suitable party managing the affairs of the person of unsound mind as compared to the parent or guardian, this must surely apply to HOTA as well. My last clarification. The Minister earlier asked who would behave like opting out of HOTA but opting in for MTERA, as the question posed by Mdm Cynthia Phua.”
“Sir, may I now seek clarification on certain clauses of the Bill? Section 5(2)(f) of the Act suggests that there is no authority to remove organ if the designated officer, after making inquiries, has reason to believe that person was not of sound mind, unless the parent or guardian has consented to such removal. I understand that, legally, if a person is already classified as of unsound mind, a committee of estate will be appointed to take care of that person's estate. If this is the case, the consent to be sought should be from the appointed committee, instead of the parents or guardians. Therefore, should this section not be amended to include consent to be sought from the committee of the estate, if any? If the designated officer, after making inquiries, has reason to believe that the person was not of sound mind, it ought to be deemed that no authority was given. The rationale is that person would not be in a position to decide whether to object to the removal of his organ and submit the objection. Sections 9 to 13 (Part III Registration of Objection) suggests that any person objecting to the removal of organ will be given an acknowledgement form and, if he subsequently changes his mind, another form will be given to him. In this case, there will be several forms in the hands of his next-of-kin and this may cause confusion and may lead to the next-of-kin questioning this perceived discrepancy. In this way, may I suggest that a new clause be added to state that, in the event of discrepancy, the information recorded in the register shall be final and conclusive of the election of the person. I hope the Minister can enlighten us on the points raised.”
“Are there safeguards to protect the interests of the donors because there is a risk of death or long-term medical complications? How do we ensure that the medical costs incurred in the course or as a result of donating their organs can be addressed? Will those Singaporean recipients and donors who cannot afford to pay for their medical bills fall under the safety net of Medifund? How will this new proposed Bill affect foreign patients seeking organ transplant in Singapore? Sir, Muslims have been excluded from HOTA; therefore, Muslims waiting for a kidney transplant will naturally have a very low priority. May I ask the Minister how he is going to address and help Malays who are apparently at higher risks of developing kidney disease? Kidney disease treatment, such as dialysis, is not only a costly but also a long-term liability and this will cause hardships to many Malay families. In the past, Muslims signed up as donors on finding out they had kidney failure so that they were eligible when they needed the transplant, usually several years later from the onset of kidney failure. Can they continue this practice? Sir, I would like to urge the Ministry of Health to step up public education not only about HOTA but also to equip the public on how to prevent the need for organ transplants. As we know, the majority of kidney failure cases here have been the result of diabetes and hypertension. Therefore, healthy lifestyle promotion for prevention of disbetes and hypertension, early diagnosis of these conditions and good control of these conditions will help us reduce our need for more organ transplants. All efforts must be enhanced and monetary issues addressed, especially towards helping those who are poor to pay for their long-term medications for these chronic diseases.”
“Many reports in the media had published how "brain death" patients had woken up after years of being in coma. One such case was noted in Europe recently - the patient was apparently in coma for 18 years. For the loved ones of many certified brain death patients, the acceptance of brain death is heart-wrenching, especially when this is instantaneously followed by the removal of the organs of their loved ones. How does the Ministry of Health ensure that organs are not removed prematurely? I have read that in the United States, the whole brain must stop functioning for a diagnosis of "brain death" whereas, in Britain, brain-stem death is enough. Which one are we following in Singapore? This Bill will expand the organs for transplant to include the cornea, heart and liver. Some have questioned why corneas should be included in this Bill as cornea transplants do not save lives and corneas can be imported easily. Cornea transplants have not been affected here in the past and nobody has been deprived here of cornea transplant. The argument against including the heart is that, since not many heart transplant operations are being done here, why is there a need for that organ presently? Also, due to their religion, some have expressed that they are uncomfortable with the idea of having no hearts in their after-life and having no sight if they had their corneas removed. This Bill will regulate the living organ transplant. May I seek clarification from the Minister on a few points here? How is his Ministry going to regulate on the criteria concerning living donors and prevent abuses with regard to the deterrent measures? How is his Ministry going to ensure that donors are not under financial inducements or emotional coercion and duress to donate their organs?”
“Mr Speaker, Sir, I stand to speak in support of the Human Organ Transplant (Amendment) Bill. Sir, I am a doctor, and as all doctors believe that saving more lives and reducing suffering are fundamental to our doctrine, I welcome this Bill for it will enable us to save more lives and give more quality life for many patients. However, I do have several concerns with regard to this Bill. I feel that this opt-out scheme of HOTA is too imposing. I would have preferred just an opt-in scheme. Many have expressed disgruntlement that their body organs automatically do not belong to them after death. Although they can opt out, there is a penalty for doing so under HOTA. The explanation for the opt-out scheme has been that the opt-in scheme enacted under the Medical (Therapy, Education and Research) Act (MTERA) since 1972 drew very small donor response. My point is that, with our affluent society, it will be more civic to invite people to donate their organs rather than compelling them to do so through regulations. Is it right to base the poor response of our past record of our opt-in scheme for our decision to expand HOTA now? In the past, no concerted efforts were tried by MOH on public persuasion or public education to get donors to better promote our opt-in scheme. Could it be that the opt-in scheme has failed from the lack of effort on the part of the Ministry? Are we being seen as taking an easy way out again without even considering this implication of compulsion on the people? Is it right for us to progress as a society in this manner? Brain death issue has been controversial. The worrying fact for many is whether people certified with "brain death" is really dead.”
“We have been working with some of the institutions, such as KKCH, where they have started a very succesful infant care. We have also worked with some VWOs. Mr Lim Hng Kiang has announced recently that the Government is looking into this area actively. So we hope to finish some of the studies in this particular area so that we can help young couples who have decided to have children to be able to balance both work and family commitments. On the incentives for the first child, I agree with the Member that we do not have any incentives on, what we call, the non-tax measures. The Baby Bonus Scheme is meant for the second and third child. The first-child benefits are channelled through the various tax measures. But having said that, Sir, so far we do not see a problem, in terms of families having one child. The challenge is to try and tweak the incentive in such a way to encourage families to have a second and third child. And that is why when the Baby Bonus Scheme was announced in 2000, it was meant only for the second and third child. And there is a reason for that, Sir. From the financial point of view, having two or three children, the cost incurred, in terms of the expenditure for childcare needs, will certainly increase with the number of children. At the moment, we are not considering non-tax incentives. But there are currently tax incentives for having the first child.”
“May I ask the Minister whether the financial incentives should also be extended to the first child to encourage more young couples to start a family? May I also ask him whether his Ministry is doing enough to make the environment more conducive to encourage couples to have children? For example, are there enough quality and affordable childcare centres, especially for infants, and in view of our increasing dual income families, is his Ministry doing enough to promote the mindset of both parents being providers as well as nurturers? Assoc. Prof. Dr Yaacob Ibrahim: Sir, to the last question, I will leave it to the families to decide on how to balance the family chores between the husband and wife. It is very difficult for Government to intervene to tell the husbands to take part of the role from the mothers. But I agree with her on the role of parents. However, most men nowadays realise that they have a role to play in not just providing for the family but in nurturing their children too. For example, we have a Centre for Fathering that has been around for several years to encourage fathers to be more responsible towards the development of their children. I agree with the Member, Sir, that we need to provide enough supporting structure for our families. So childcare centres have been provided. We have about 638 childcare centres in Singapore. There are still sufficient places, and there is a wide range of childcare centres, not only for the top end or those who prefer more enrichment classes, but even for basic childcare facilities, there are enough places. The challenge is actually at the infant care and that is where we are trying to encourage the development.”
“Like fighting SARS, we are in the same team. I intend to use the same SARS approach to fight obesity, diabetes, hypertension, rising healthcare cost, and that means you and I together, with many others outside of this House, united as one team, fighting one common enemy. That way, we increase our chances of achieving progress in all the eight priority areas.”
“I take an inclusive approach, involving other Ministries, agencies and other stakeholders. For example, in pushing healthy lifestyle, we cannot do it alone. We need MOE, MCDS, PA, MNCs, NTUC, SMEs, students, teachers, etc, to help champion the cause, if we are to make a significant difference. And Dr Lily Neo is absolutely correct that we need creativity and enthusiasm in healthy lifestyle promotion, involving all and sundry, young and old, men and women. And I was glad that when we launched the Healthy Lifestyle Campaign this year with a run in Bishan Park led by DPM Lee, among the runners was a representative from the Government Parliamentary Committee for Health. I hope to see the entire GPC at our next campaign. And Mdm Deputy Speaker, we will be honoured if you can also join us! And hearing Mr Chiam just now, who was very passionate about running and about fighting obesity, I think he will also join us! Last week, I read in the IHT how a US telco MNC, Sprint, a large company, is promoting fitness among its employees. It is targeting obesity and, in its brand-new global headquarters in Kansas City, it bans cars, forcing its workers to park and walk - I suppose they can cycle - from one kilometre away. Although a brand-new building, it chose old-fashioned hydraulic lifts, very slow, but the staircases have wide windows, to encourage the workers to walk between floors. And Sprint is not alone in taking more aggressive measures to get its workers to move more and to eat less. The new measures are going beyond putting gymnasiums in office buildings or promoting the eating of broccoli. These are useful tips for our companies here, including Parliament House! In short, Mdm Deputy Speaker, I am cheered by Dr Lily Neo's support and advice.”