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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“I beg leave to withdraw my amendment. Amendment, by leave, withdrawn.”
“Furthermore, upgrading would allow them to enjoy the better quality of life enjoyed by their cousins in upgrading HDB homes. Sir, this is a pressing problem and is especially so for some of the older developments which are in a very sad state of disrepair. It is quite difficult, indeed, to garner enough support from their residents to carry out any major upgrading project, especially when it involves substantial expenditure. Allowing the use of available CPF funds will certainly reduce the awesome burden of any outright payments for the upgrading. This is even more significant for owners of the older condominiums who are elderly or retired and may not be able to afford to contribute the thousands of dollars involved. I beseech the Minister for Manpower to look into the above issue.”
“Sir, I beg to move, That the sum to be allocated for Head T of the Main Estimates be reduced by $10 in respect of Code TA 1500 Sir, many of our old HDB flats have been upgraded to ensure that they do not degenerate into an unsightly dilapidated state. Old private estates deteriorate as well and they should be similarly upgraded. I am heartened therefore when the Ministry of National Development on 17th October 2000 released its Estate Upgrading Programme (EUP) and had chosen five private estates as the first batch for this programme. However, such EUP only applies to public areas and does not cover "works on private land and facilities, including common areas and properties of condominiums and private apartments". Going further and having these old condominiums and private apartments upgraded as well would be even better for the estates. Whilst the private owners themselves are expected to bear the expenses for this, I feel that the onerous burden for such payments should be facilitated. 1.30 pm Currently, owners whose HDB homes are owner-occupied and who are below 55 years of age can withdraw their CPF savings in the Ordinary Account to pay for the upgrading. As an MP who has many residents who are private condominium owners, I hear their frequent calls for the use of available CPF savings to offset the costs of upgrading their property. Dwellers in the private estates feel that they should be given the same kind of privileges and be allowed to use their CPF savings to upgrade their homes. Many of my residents have argued that, similar to upgrading of HDB flats, upgrading of their apartments is a form of asset enhancement, as the value of their flats will be enhanced.”
“Sir, I beg leave to withdraw my amendment. Amendment, by leave, withdrawn.”
“Sir, in fact, the advertisements were in that category. Advertisements have also been made for hair removal by FDA-approved light activated systems but they used probably Class-4 laser device.”
“Sir, may I seek further clarification? To reiterate, advertisements are put up freely by these beauticians. If you say the Ministry would pursue this matter, why has it not acted earlier on all these advertisements?”
“May I seek clarification, Sir. May I ask the Parliamentary Secretary whether the Ministry would take any further action to cope with these prevalent surgeries done by beauticians, and what else could be further done to improve this area.”
“15 pm Sir, of what use are the Acts if such illegal activities continue to flourish unchecked? Medical professionals are brought to task for advertising themselves, let alone making misrepresented advertisements, but beauticians are free to advertise, lure and treat customers. Sir, these beauticians are not authorised to perform invasive surgery, and they should be stopped. I would, therefore, like to urge the Ministry of Health to pursue and address the stark discrepancy in this area.”
“Sir, I beg to move, That the sum to be allocated for Head P of the Main Estimates be reduced by $10 in respect of Code PA 2300. Surgery by beauticians. Sir, we pride ourselves for having a first-class medical healthcare system with world-recognised and well-qualified surgeons who will carry out the best operations for their patients. We also have all our doctors under surveillance to provide the best medical practices and bring them to justice for any misdoings. Whilst we ensure medical ethics and excellence with the medical professionals on one hand, we allow beauticians, who are not competent, to freely perform surgical procedures, on the other. Sir, reports made to the media and the Consumers' Association suggest that some methods used by beauticians are invasive and come with attendant risks of injury and infection. Laser devices are being used freely. This is borne out by the profusion of advertisements promoting hair removal by beauticians using "FDA approved light activated systems". It is likely that Class 4 Laser Devices are being used for this and this would contravene the Radiation Protection Act which states that non-medical professionals are licensed to operate only Class 1, 2, 3a and 3b lasers. Other procedures performed by beauticians include silicone injections to the nose and breast, removal of tattoos using CO2 lasers and blepharoplasties. Not only do they contravene the Medical Registration Act, these beauticians also pose potential hazards when they "operate" on unwary clients. Sir, many beauty treatments have gone horribly wrong because people have been ill-informed and were taken in by misleading and bait advertisements, especially for blemish removal, eye-lids and nose jobs. 3.”
“Sir, I want to thank the Parliamentary Secretary for agreeing with all my suggestions. I beg leave to withdraw my amendment. Amendment, by leave, withdrawn.”
“Rehabilitation. Sir, everyone who has had an illness or accident needs some time to recover. In other words, they need rehabilitation. Older people who need rehabilitation usually suffer from a wide range of conditions and their needs are often complex. Rehabilitation involves restoration to the maximum degree possible, either of function (physical or mental) or role (within the family, social network or workforce). Rehabilitation usually requires a mixture of clinical, therapeutic and social interventions that also address issues relevant to a person's physical and social environment. Effective rehabilitation needs to be responsive to the needs and wishes of the user and has to be purposeful with the involvement of a number of agencies and disciplines. It must also be made easily available when required. Sir, there is strong evidence that comprehensive assessments, followed by implementation of individual care plans, can reduce the risk of older people being re-admitted to hospitals or placed in long-stay care. It also improves survival rates and physical and cognitive functioning. To do all these, we need the involvement of relevant therapists, in particular, we need occupational therapists, speech and language therapists and physiotherapist. Sir, I would like to ask the Minister for Health if he would ensure that we have enough of such therapists to give patients the ideal rehabilitation they require and whether he would expand this area.”
“In England, it takes only three weeks of intensive training to equip them with the necessary skills. They are certified at the end of the course which teaches them in assisted feeding, catheter care, prosthesis use, simple dressing and simple grooming as in toenail cutting for non-diabetics using sterile techniques. We are still very short of nurses in Singapore. Whilst I feel that the Ministry of Health must seriously consider training more healthcare workers to help ease this shortage, I urge that we have to do much more to increase our supply of nurses. I am glad that the Ministry of Health has taken a step in the right direction with an upward revision of nurses' salaries from 1st June this year. Sir, it is not only necessary to make the nursing profession noble; it is also necessary to make the job family-friendly and lucrative in terms of both career development and monetary unions. Shall I go on to my last cut? The Chairman: Yes.”
“Yes, Sir. Nurses constitute an integral and important part of any healthcare system. Success in training nurses and training enough of them is vital for sustaining the excellent and efficient healthcare system we now enjoy. Sir, nurses who are well trained can do a lot and they contribute not only to better care of patients but also to lower costs in healthcare delivery. It is very much cheaper to maintain a nurse as compared to, let us say, a doctor. Well-trained nurses can carry out many functions otherwise performed by doctors and this frees the latter for other duties. A nurse in a community clinic can be trained to check patients and assess them for appropriate referral, give post-operative care, make domiciliary visits and monitor patients with chronic illnesses. Nurses can be trained to provide care in very specialised situations too. They can be trained to look after vexing psychiatric and dementia patients, taxing bedridden and incontinent stroke patients as well as disheartening terminally ill patients. Sir, as we try to cope with our ageing problem, nurses will be required in even greater numbers. The challenge for us is not only in having adequate numbers of nurses but also in training enough of them for the impending demands of eldercare. As our policy will be to assist older people remain as independently for as long as possible, preferably in their own homes, more courses are needed to train more nurses for the community care setting to achieve this end. Apart from training the nurses, the Ministry of Health should also have courses that cater for healthcare workers. These healthcare workers can be full-time paid personnel, family members, community volunteers, and so on. Such healthcare workers can be trained in a matter of a few weeks.”
“(10) The role of the different professions in delivering cost effective and life enhancing care. Sir, I would like to urge the Minister for Health to incorporate the above important considerations to ensure the success of the care of long-term medical needs. Success in this area will lessen the burden of Singaporeans and the state in the long run.”
“Sir, I beg to move, That the sum to be allocated for Head P of the Main Estimates be reduced by $10 in respect of Code PA 1500. Long-term healthcare. Sir, many Singaporeans are concerned about rising medical costs and this is especially so for the elderly folks in our midst who have no income but have 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 the Ministry of Health to have good plans, insurance schemes and various safety nets put in place to ensure the affordable long-term healthcare for all Singaporeans. I would like to suggest that we observe the 10 basic tenets for such long-term healthcare as follows: (1) The culture of self-reliance and taking personal responsibility. (2) The premise that early preventive measures are preferable and more effective than later interventions at points of crisis. (3) The view that the family unit, with adequate support, is the principal way to provide care in the home environment rather than residential care. (4) The recognition that residential care is costly and causes loss of independence. (5) The need to involve the communities to facilitate the elderly to stay in the communities and at their own homes for as long as possible. (6) Funding for long-term healthcare must be fair, equitable to all generations and sustainable over the long term. (7) A combination of services may be required, including personal or medical care, equipment, transport and domestic support. (8) Older people often have a variety of inter-related needs, including nutrition, nursing, medication and mobility management. (9) The importance of support for family and other informal caregivers.”
“I hope, therefore, that the Ministry of Health will look into these issues soonest possible.”
“The challenge for MOH on the care of the elderly will be in assisting them to live as independently and for as long as possible in their own homes, with appropriate support. Sir, the aim is to maximise independent living and social functioning, and to minimise avoidable hospital admissions and premature or avoidable dependence on long-term care in institutional settings. There should be appropriate support services to help maintain the frail elderly in the community for as long as possible. Home-care with domiciliary services, and day-care with rehabilitation facilities as well as occupational therapy services with the equipment and adaptations at homes, should be made readily available. It is also necessary to garner ample community help and community volunteers to deliver the services. 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, VWOs and the media, to encourage Singaporeans to go for early health-checks and treatment. MOH must provide early treatment for the sick elderly. An important message for this target 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 chronic diseases can get their regular long-term medications. Sir, if a preventive care scheme is not provided for those elderly who are well, illnesses causing disabilities will occur more frequently. This will, in turn, lead to more hospitalisations and higher costs. If the community-based services are inadequate, more re-admissions to hospitals or institutional-care centres will again lead to higher costs.”
“Sir, there is little doubt that one of the biggest challenges for the Ministry of Health now is to ensure that healthcare for the elderly will be efficient and affordable in the years ahead. We should be proactive in planning and we must start laying the foundations for eldercare with urgency to ensure success in this area. Sir, a favourable outcome in this aspect will make the inevitable escalation of healthcare costs a lesser burden for the people and the Government. It will also make life a happier and healthier one for our elderly population. We must be especially painstaking at putting in place a scheme to cope with the very old, those aged 75 and above. There will be an almost three-fold increase of this group that is most likely to depend heavily on our healthcare and social services. A one-stop diagnosis and care-plan centre is essential. At this centre, a standardised and holistic assessment can be done according to the patient's needs. Having the correct diagnosis and the choicest management for each illness will not only result in a better outcome but also save us money. Referral to the correct doctor and discipline for treatment are essential for a reduction in hospital admissions. There must be help to promote independence by supporting people to achieve their best potential and strengthen families and communities by supporting family and community responsibility. To do this, we have to start training for more medical personnel. They include geriatricians, physiotherapists, community nurses and home-care nurses and care-givers. New courses need to be conducted to teach the various types of care, especially community healthcare. I feel MOH should not hesitate in organising a team to look into establishing such a centre.”
“Whilst we cannot arrest the rising medical demands and the increasing costs of healthcare, our challenge is to find all avenues available to lessen the need for expensive medical care. It would appear that the basic tenets for a good and affordable healthcare system seem to rest upon a system that enables us to: 1. maintain our population as healthily and for as long as possible; 2. ensure the elderly population remains as independently as possible; 3. ensure the appropriate use of our medical care without wastage; and 4. emphasise on self-help and that people are responsible for their own health. Sir, we must go beyond rendering remedy only when sickness strikes. We need preventive care. It is crucial to promote preventive care with more resources provided for it. The Community Health Screening programme, embarked by MOH for citizens above 50 years of age, is on the right track. The challenge now is to facilitate those diagnosed with any of the chronic diseases to go for long-term follow up and treatment. Failure here would make the whole programme a waste of time, effort and money. Perhaps, we should consider subsidy, either through MOH or CDC, to defray some of the costs for those who really cannot afford long-term treatment. I had previously asked in this House that more help be given to voluntary welfare organisations (VWOs) so that they have less fund-raising burdens. Fund-raising can be a very tedious task indeed. It gets harder each year, with increasing numbers of fund-raising events. It detracts the VWOs from their good work in caring for their charges. I sincerely hope the Minister for Health will accede to my request to give them more help.”
“In the ensuing years, Sir, we can expect increased demands on our healthcare system as a result of higher needs of a fast ageing population, higher expectations of an increasing affluent population and higher usage of new medical advances. The cost of healthcare will be a cause for concern as we face the challenge to ensure the affordable quality healthcare that Singaporeans have grown accustomed to. Sir, planning and spending now to address the issue will save us millions of dollars in the future. The Finance Minister has increased the FY2001 budget allocation for the Ministry of Health by 31%. This is heartening and I would like to urge the Minister for Health to spend not only on immediate healthcare needs but also on the foundations that will take care of our future healthcare concerns. In this respect, I have several observations to make as follows: 12.00 noon Our National Healthcare Expenditure, which formed about 3.1% of GDP in 1999, amounted to $4.4 billion or $1,370 per capita. The public healthcare expenditure is 1.1% of GDP and the private healthcare expenditure is 2% of GDP or twice the amount spent by the Government. This contrasts significantly with that in England where the private share is only 1/6, in Australia where the private share is only half, and in Hong Kong and Malaysia where the ratio is roughly one to one. Sir, the healthcare burden on the people is high in Singapore and we should try to lessen this burden. The Minister may like to consider having more healthcare benefits for children. Such a reduction of healthcare burden on the people may induce more couples to have more children.”
“Sir, we should control and regulate suppliers through legislation to protect Singapore consumers better. As my parliamentary colleague, Dr Teo Ho Pin, has said much of what I wanted to speak on, I will only repeat his call and urge the Ministry of Trade and Industry to consider introducing a Fair Trading Act. I will only add that such a Fair Trading Act should contain provisions that make it an offence for suppliers to: (1) make false or misleading representations in relation to the nature, characteristics, suitability or quantity of the products or services; (2) engage in conduct that is unconscionable; some examples are where the supplier unduly influences, exerts pressure or uses unfair tactics on consumers; (3) engage in misleading and deceptive conduct in relation to the goods or services; and (4) use bait advertising to lure customers, eg, a supplier cannot advertise a service at a particular price with no expectation of honouring it. Sir, I hope the Minister for Trade and Industry would consider introducing such an Act.”
“Spending now to meet this challenge will save us millions of dollars in the future. I am glad that the Minister for Finance recognises this and has started to address the issue by providing substantially more funds for healthcare. I hope the funds will be used to establish the foundations for a sound "Healthcare 21". Sir, in conclusion, I wish to reiterate that it requires the concerted effort, through close networking and smooth implementation of policies by various Ministries, that would ensure us our success in this issue. Therefore, I would urge the relevant Ministries to garner all their resources and work as one entity for the better of our aging nation.”
“We must have the personnel, in ample numbers, to assist people with appropriate support to assess medical conditions, advise nursing care, provide home-help courses, and suggest necessary home adaptations and so on. This means a standardised and holistic management of the needs of each family, and an assurance of appropriate care that spares them lots of worry, time and effort. To have this, we have to start training more medical personnel in various fields. We must have more geriatricians, physiotherapists, community nurses, home-care nurses and home-care helpers. We need "new courses" to impart ideas and experiences of experts in other countries that have gone through this predicament long before us. We can certainly benefit by looking at others in their management of workable systems. A centre or bureau with a dedicated team may be set up for this. It will augur well for us if the Ministry of Health looks into this immediately and the Ministry of Finance funds for this generously. Sir, the task in the ensuing years may seem insurmountable due to foreseeable increased demands on our healthcare system as a result of greater needs of elderly folk, expectations of affluent citizens, and costs of new medical advances. Whilst we cannot arrest the rising demands and costs, we can challenge ourselves to find and implement the ways to lessen the burden. Promoting "preventive care" to maintain a healthy population for as long as possible will be the basic tenets of our endeavour. The target is to help the older people to live as independently as possible, deliver good medical care at affordable costs, ensure appropriate use of medical resources without wastage, emphasise self-help, and stress responsibility for one's own good health.”
“We must help the older people maintain independent lives in the community for as long as possible, being aided predominantly by the community healthcare services. As people get older, the emphasis should shift from the extension of life to the improvement of health-related quality of life. In other words, the emphasis should be on "adding life to years and not years to life". Mr Speaker, Sir, I would like each one of us here present to consider the scenario of having to care for one of our very own elderly parents who should fall ill. This is not an unlikely scenario as many of us do have elderly parents and one in four in our population will face the situation in the not-too-distant future. It is a matter of time when we would have to meet that call. If faced with that situation now, you may be wondering where to look for help. Must you seek specialist help and, if so, which and how many specialists will you need to send your parent for proper diagnosis and treatment of the different illnesses, which older people can have? How are you going to provide the care if he or she is semi-dependent and you needed to be at work? Do you have the know-how to care for a totally dependent elderly? If he or she insists on staying at home and rejects the idea of care in a nursing home, how do you then cope with all the daily medical requirements? Sir, what I am getting at is to illustrate our need to have in place a healthcare system that provides a one-stop centre which you can call upon to handle such a distressing scenario. Sir, we should plan a system that promotes independence by supporting people to achieve their potential, and strengthen families by supporting family responsibilities.”
“As we plan ahead, we need to turn full circle, and adopt policies and programmes, provide retraining opportunities, offer flexible work hours and encourage those who want to stay on the job to do so. Sir, it is prudent that MOM is continuing to review the retirement age. Many older people can stay longer in the community with structural adaptations made to their own homes. The Ministry of National Development should facilitate this by having modifications done to older flats, occupied mainly by older folk, in similar fashion to those modified for some rental HDB blocks. Mr Speaker, Sir, having seen those modified rental HDB homes, we know what can be done. The more elderly-friendly features inside the flats and the access or surrounding areas are, indeed, a boon to the older persons. MND should also facilitate owners of HDB flats in the existing and new HDB flats to modify their homes, if they so wish. Furthermore, MND should also have sheltered homes, studio apartments and retirement villages built in increasing numbers to meet increasing demand through time. Sir, it would be good if MND has schemes in place to encourage private organisations to build such homes. Mr Speaker, Sir, the Minister for Finance has said that, as our population ages, the healthcare costs for the older generation of our people will rapidly increase. This is the reason why allowances were made to meet the projected healthcare costs in the years to come. The challenge now is to ensure that we can continue to spend wisely and efficiently in the future. The current 8% of older persons account for 20% of all outpatient attendances and 18% of all hospital admissions. Sir, going forward along such a trend, we will be putting a tremendous burden upon our healthcare resources.”
“Mr Speaker, Sir, as we figure out how to best prepare for our aging population, half the battle would have been won if we could influence Singaporeans with the correct mindset concerning older persons and retirement. A mindset change needs time and a lot of effort to nurture, and I would like MCDS to prioritise it and enable us to achieve the desired outcome. Sir, older persons should be regarded as useful citizens whose wisdom, skills and talents are valuable resources that must be tapped for as long as possible to benefit society. The mindset on retirement should be: "A time to begin a new chapter in life by being active and involved; starting new activities and setting new goals." Indeed, Sir, older people can approach aging and retirement in new and exciting ways, and MCDS can do much to help them realise such a goal. A new survey of 803 American men and women aged 50 to 75 has found that 40% of them are working or plan to work after they retire, while an equal percentage plans to do volunteer work. Mr Speaker, Sir, the Ministry of Manpower should encourage and facilitate this type of attitudes by providing avenues for Singaporeans to remain at work and to do volunteer work. Matching the seniors to further training or job placements should also be enhanced. Older people should be given training opportunities irrespective of age. This will enable them to receive skills upgrading and help them stay relevant in the economy. Sir, people are healthier and are living longer. A skilled labour force of "seniors" can, therefore, be a valuable asset. Companies wishing to retain their older workers through workplace re-engineering should be encouraged and facilitated in this respect.”
“Easy access to these community care facilities, vis-a-vis centres of activity, centres for rehabilitation and daycare centres, is essential. There must be unstinted availability of support and advice. MCDS should facilitate this area by involving community bodies such as voluntary welfare organisations, grassroots organisations, and other groups in the private sector. Such facilitation will translate into lower costs and convenience for a happier people. Sir, volunteer opportunities should be made available and seniors should be made aware that their skills are valued. We have a large and increasing pool of volunteers to tap from among the older Singaporeans. Training them to be competent in the different areas of our needs will give them recognition and worth. For example, as we are lacking in the community services to support and care for the frail and semi-dependent in the society, we may perhaps equip and train these volunteers to provide them. Perhaps, a well-managed register of volunteers and matching services can ensure successful implementation of this type of volunteerism. Volunteers should be recognised for their work, and it would be good if they can get some privileged and subsidised care when, in turn, they themselves need community services. They should be reimbursed transportation and minor costs of incidentals. MCDS should also look into another important area. There is a need to facilitate adaptations, either with structural modifications to the homes, or with provision of appropriate equipment to ease the inadequacies of the frail or semi-dependent elderly. This will enable them to continue living in their own homes for as long as possible.”
“Mr Speaker, Sir, our priority is to have in place a system that strengthens our foundation and taps and maximises our voluntary and private sectors. I would like the Minister for Finance to consider the importance in laying the foundation and the infrastructure immediately. Additionally, I would like the different Ministries, such as the Ministry of Community Development and Sports (MCDS), Ministry of Health (MOH), Ministry of Manpower (MOM) and Ministry of National Development (MND) to appropriate proactive measures to make some significant impact over this issue. For MCDS, I would like to suggest that since our primary objective in the care of the elderly is to enable them to maintain independent lives in the community and in their homes for as long as possible, maintaining the social status quo in those elderly who are well and those elderly who are not totally dependent, should be one of its primary objectives. Thus, by postponing or retarding the functional deterioration in these older persons, MCDS can help them reduce avoidable hospital admissions and minimize premature dependence on long-term care in institutional settings. Sir, the aim must be to help the older persons do things for themselves; not do things for them. For this to happen, there must be effective support from primary healthcare, community healthcare, social services and modified housing. There must be ample community volunteers and home help for families to care for the dependent elderly in their homes. As a matter of urgency, MCDS should have homecare-cum-domiciliary services, daycare and rehabilitation services, occupational therapy services with equipment and adaptations at homes developed and established.”
“I thank you, Mr Speaker, Sir, for allowing me to join in the debate today. Whilst I agree with Members of this House who have spoken earlier that the Budget for this year is a generous one, I feel that it has inadequately addressed our concerns in preparing for the future needs of a fast-ageing population. Sir, Singapore is indeed facing a fast-ageing population with the "older dependency ratio" decreasing from 10 now to over 30 by 2030. This is worrying. But even more worrying and dramatic will be the increasing number of the very old (those aged 75 and above). This group represents the frail elderly with physical, mental and social limitations. This is the group that is most likely to depend on and tax our health and social services. There will be an almost three-fold increase of this group from just over 90,000 now to about 250,000 by 2030, when it will comprise about 7% of our total population. Sir, we need good planning and astute allocation of immediate resources for a smooth transition to the years ahead. Older people are more likely to have disabilities; the challenge is to attain a position where we can provide care that allows them to live independently for as long as possible and, preferably, in their own homes with their families. In order to achieve this, I would like to suggest that, henceforth, certain incentive grants be set aside for relevant Ministries to plan and act on innovative ideas that will save us from challenging burdens later on. Incentives should be given for proactive measures that can improve the care of the older generation in future. In view of the daunting task of caring for so many older people in the not too distant future, we have to start working on this potential problem now.”
“Shopkeepers should be encouraged to join the Business Liaison Committee of the Town Councils to address their concerns. Liberal approval for pasar malams at HDB estates should be weighed against the impact on the neighbourhood retail businesses. The Ministry of Trade and Industry announced the Retail Sector Development Plan (RSDP) in March 1992. This is a comprehensive plan to give the small retailers a chance to survive in this competitive environment. This plan, Sir, should be extended and carried on in a faster and more organised fashion. It should be undertaken in partnership with all concerned. The sheer size of the sector and the complexity of the task require close and ongoing consultation and collaboration between the public and private sectors, and between the planners and the people. Sir, the solution to the problems of the SMEs, especially the HDB retailers, is in restructuring that will collectively improve them and keep them relevant to the present trends and lifestyles of consumers. This needs the efforts of SMEs, private associations or organisations and Government to work hand in hand. The majority of our SMEs are not doing well in spite of a double digit growth last year. Their prospects are not rosy and they require the concerted efforts of all concerned to help them keep pace with the rest of the economy. Their transformation needs time and a lot of effort for fruition. Sir, I beseech our Government to prioritise this matter and, in the interim, lessen their pain with immediate rescue measures.”
“Relocating shops in poor locations and poor market conditions to better business areas. Having the option of selling their shops back to HDB. Sir, may I urge HDB to review the planning of HDB shops spaces. In view of the present trend towards mega shopping malls and supermarkets, there is a need to reduce and restructure the HDB shops, not only in terms of new supply but also in consideration of existing ones. Perhaps, HDB can improve on the defining terms concerning the variety of trade mix. Poor distribution of trades and services seems to be a common problem in the town centres and neighbourhood centres. A survey of the retail outlets in the town centres of Bedok, Clementi and Toa Payoh showed that the predominant trades are personal items (shoes, bags, accessories), clothing and miscellaneous retailing. For the neighbourhood centres, the survey conducted in the Bedok neighbourhood showed that the predominant trades are provision shops and personal services such as barber shops and hairdressing salons. There is insufficient variety of trades and the choice of goods and services is limited in most HDB town centres and neighbourhood centres. HDB shops can be regrouped to form "commercial streets" of distinctive features to be in a better position to compete with giant shops. Representatives for retailers like the Merchants' Association and the Singapore Retailers' Association can work with the Government to bring this about. Town councils can help by improving the physical infrastructure in the business neighbourhood. Town councils must help by injecting life into the business neighbourhood to attract the shopping crowd. There should be more effective use of festivals, eg, Mid-Autumn Festival to attract residents into the shopping areas.”
“This is especially so for the shopowners who have bought their shops in 1995 and 1996; some of them have as much as $8,000 per month in repayment of their loans. The businessmen who bought the 99-year leasehold properties have very heavy burdens in lieu of high monthly repayments. They are in a dilemma because the market is extremely weak and they cannot afford to sell their properties when market prices are so low. It is very sad indeed to hear that some of them are barely able to cling on to such a bad predicament and can see no foreseeable respite. Sir, some of them mortgage their own homes to stay afloat and it is only a matter of time before they lose their homes as well. These people are hoping that their businesses will improve. Alas, I fear that they are hoping against hope under present circumstances. In the past, when the property market was buoyant, they could take solace and comfort on the assurance of having valuable assets in their properties. Those who have purchased their shops from HDB now face a double whammy of poor business and poor property prices. What can be done here? I would like to echo their requests. Most people agree that HDB must have some sort of planning and control to ensure that no overwhelming duplication of similar businesses occurs in one area. Granted that such an occurrence is detrimental for one and all, they would like HDB to allow more flexibility in the conduct of their businesses as in: Allowing splitting of the shops into smaller shops to co-exist with other types of businesses. Granting "change of use" of their shops and allowing them to be converted into offices or wholesale shops either temporarily or permanently. Resettling some retailers to other places that have better need of their kind of trade.”
“It would be useful if we can allow more flexibility of the SME Financial Scheme and allow shopkeepers to have repayment of loans with instalments over a longer period when times are bad. In terms of the restoration of employers' Central Provident Fund contributions, this group feels that the GDP statistics collated do not reflect accurately their performances. They propose that the authorities collate and release statistics on a regular basis, in order to set them apart from the large enterprises. SME 21 is a 10-year strategic plan launched last year to create vibrant and resilient SMEs in the new economy. Sir, as many of our SMEs are not doing well, I do urge the Government to speed up implementation of SME 21 with more resources and with a sense of urgency to assist the SMEs. High property cost and rental have been cited as a major factor for the many problems SMEs face. Many say that rental cost has become a tremendous burden to them due to their poor business. Retailers who rent HDB shops have asked for a reduction in rental and some have suggested a minimum reduction of 20%. Those who paid property tax have also asked for a further extension of the 25% property tax rebate. It has been suggested that, just as hawkers are compensated for giving up their stalls, those who wish to retire or are affected by redevelopment should also be compensated for giving up their leases. In the Sale of Tenanted Shops (SOTS) Scheme, launched in 1992 and discontinued in 1998, some 8,000 of the 10,000 eligible shops were offered for sale to the sitting tenants. Many shopowners were encouraged to buy their units from HDB and they now face large amounts in monthly repayments.”
“All told, these retailers declare that times are bad and they need help. No doubt, they have to bite the bullet just like everyone else in a free market enterprise. But they do have to abide by the HDB rules and regulations and these rules and regulations may be too restrictive and perhaps inappropriate for these times. I would like to suggest that our Government, together will all relevant authorities, make a concerted effort to help them. Perhaps, we should look into the following areas for a start. Much can be done to help the small retailers become more competitive and more in sync with consumer attitudes and shopping preferences of shoppers today. New skills and management ideas can be taught and the Government can be of assistance in this respect by providing: Training on aesthetics and presentation and on marketing and personalisation of services. Instead of allowing products to be haphazardly laid out, retailers can be shown how to improve layout and appearance of their shops to attract customers. Instead of traditional practices, retailers can be taught how to provide personalised service as a niche area by offering a familiar, friendly experience to the neighbourhood customers. Their training courses should be tailored to suit them. For instance, more courses should be conducted in Chinese to cater to the Chinese-educated. A conduit for bulk purchasing so that the retailers may save on costs. The small retail shops may be encouraged to band together so that they may improve their stores and enhance shopping experience. A good example of how this banding together can work can be seen at Chong Pang City in Yishun. Computer training to introduce these retailers to the concept of e-commerce and trading through e-commerce.”
“Thus, these SMEs are losing out to supermarket chains and big shopping malls which offer one-stop shopping and appeal to the young with their up-market image. Sir, as this trend continues, these retailers will find their clientele shrink year by year. Local SMEs employ 51% of our workforce. They make up about 92% of all business establishments here and form an important part of the Singapore economy. At least, 90% of retail businesses in Singapore are SMEs and many of them are in the HDB estates. Sir, many SMEs have not recovered from the last economic crisis and most of them are not feeling the benefits of the high economic growth reported by our Government. In fact, they are facing more difficulties as they have to pay increasing charges such as rental, property tax, service and conservancy charges, utilities bills and transport costs. Wages for workers have also been increasing. SMEs with shallower pockets and thinner profit margins find it hard to cope with the restoration of employers' Central Provident Fund contributions. In general, SMEs have cited the high costs of doing business here as a serious problem and are extremely concerned. Many retailers, especially those who have obtained their shops by tender, lament the high rental and high prices of HDB shops. In the older estates, retailers are faced with the declining population with lower disposable income as younger people move out, leaving the older folks behind. Business had been deteriorating for many and the retailers do not have enough business to make ends meet. Shop retailers have to operate long hours, often late into the night to attract customers. Sir, many retailers fear that this situation will worsen with a lower projected GDP growth for this year.”
“Mr Speaker, Sir, I would like to declare that I am running a clinic from an HDB tenanted shop. Sir, the retail sector in Singapore, like many other small and medium enterprises (SMEs), is undergoing a dramatic change. High operating costs, fierce competition and dwindling business in the industry are threatening the survival of some 12,000 HDB shop retailers. Their growing woes and difficulties must be heard and heeded by our Government. I wish to voice their call for help and beseech the Government to extend a sympathetic hand with rescue measures for their survival. Sir, rapid economic growth, more working women and higher education levels have changed the lifestyle of Singaporeans and brought about big changes in consumer attitude and shopping preferences. Many also prefer to cross over and shop in Malaysia where goods are often cheaper. Such new trends put a toll on the local retail trade. Today, our shoppers are more sophisticated and discerning; placing more emphasis on better quality of goods, wider choice of goods and prices, more attractive presentation and more pleasant shopping ambience. There is a marked preference for mega shopping centres with exciting atmosphere and ambience. Many HDB shop retailers face stiff competition from the big chain retailers that can sell goods at much lower prices operating through economies of scale. As in the case of many SMEs, challenges faced by the retailers include weak entrepreneurial culture, insufficient management professionalism and know-how, shortage of professional technical manpower, insufficient use of technology, outmoded, unproductive methods of operation, limited ability to tap economies of scale and small domestic market.”
“May I seek clarification, Sir? I would like to clarify that I did not ask for specific types of qualified people in the medical board. I only asked for their qualifications, be it medical or others, to be specified in the Bill. The Minister earlier said that mammography will be made available to all polyclinics. I would like to ask him whether this facility is operational now. Could I also ask the Minister whether representatives from the other Ministries can be made available with this Health Promotion Board so that the implementation and cooperation can be got from other Ministries as well? And earlier in my speech, I also asked for proactive action regarding chronic cases. Could he say something about that, please?”
“I hope the Minister for Health will take into consideration my aforesaid comments. Sir, I support the Health Promotion Board Bill.”
“In clause 10(1), it appears that disclosure can only be made "at a meeting of the Board". What if there is no meeting held and a disclosure is needed to be made urgently? Can disclosure be made to the Board in writing when there is no meeting? Under clause 15(3), what if the Chief Executive is incompetent or commits an offence that makes him/her unfit to be Chief Executive? This clause does not seem to include these possibilities. Mr Speaker, Sir, clause 28, dealing with the powers of the auditors, gives the impression that the Ministry is very concerned about financial matters and hence has given a very wide power (with no limitation or restriction) to auditors. It appears that any such person may be required to furnish information, including confidential information, as long as they relate to accounts or finances. Sir, it is submitted that some form of control or limitation must be included to prevent any abuse of power by auditors and some limits must be set on documents that may be accessed or copied by auditors or at least the auditors may be required to exercise reasonableness or have a duty to keep all documents or information confidential. Although clause 39 deals with preservation of secrecy, it appears that clause 39 imposes duty only on the member, officer, employee or an agent of the Board, and auditors are intentionally excluded. Clause 40 deals with the composition of offences. May I ask the Minister why the Chief Executive may compound any offence by collecting from a person "reasonably suspected of" having committed the offence a sum of money not exceeding $1,000? Sir, why should a person who is merely a suspect be required to pay a composition fine? It is hence suggested that these words "reasonably suspected of" be deleted.”
“May I ask the Minister whether there is a need to mention pro-active actions towards preventive care in this Bill? For example, now that the prevalence of breast cancer is highest for cancers in women, as mentioned by the Minister earlier, it is essential to increase the screening of women to prevent many of them from end-stage cancers. Also, the problem of getting at those chronic-disease sufferers that do not go for long-term preventive medications that can prevent disasters like strokes, cardiovascular diseases and kidney failures, must be addressed. Under the constitution of the Board in clause 5, may I ask if there is a need to specify the qualification of the members, and especially of the Chairman, as only persons with a medical or other professional degree is eligible to be so appointed? Clause 4(1) provides that the common seal may be broken, changed, altered or made anew as the Board thinks fit. Sir, if there are such possibilities, then one may have to include a subsection to the effect that all instruments affixed with a broken, changed or altered common seal will nevertheless be deemed to have been validly executed and sealed if the execution and seal are carried out and affixed in the proper manner as prescribed in this section. In clause 9(4), does "majority of votes" mean 51% by show of hands of members present? What happens if the questions to be decided by votes involve serious consideration such as disposal of the Board's property or any dealings between members and the Board involving substantial amounts of money, etc? Is there a need to provide that at least 75% majority votes are required when a decision is to be made for such important or serious issues? Clause 10 covers the disclosure of interest of members.”
“Mr Speaker, Sir, I stand to support the Health Promotion Board Bill. It is timely and significant indeed, if by setting up this Health Promotion Board, there can be more emphasis put into the promotion of good health and healthy lifestyles amongst the people of Singapore, as stated in clause 11 of the Bill regarding functions, objects and duties of the Board. Our national healthcare expenditure, which formed about 2.7% of Singapore's GDP in 1996, had increased to 3.1% of GDP in 1999. This amounted to $4.4 billion or $1,370 per capita. This amount is projected to increase to 7% of GDP in 2030 or about $10 billion. Sir, the best remedy to reduce medical healthcare demands is to ensure that people live healthily for as long as possible, through preventive means and thus requiring less medical care. It is thus vital to have good and successful promotion of good health and healthy lifestyles. In section 11(1)(d), there is mention to monitor and conduct investigations and research. I would like to urge the Minister to ensure that the Health Promotion Board urgently concentrates on epidemiological studies of diseases that are most pressing and prevalent in our population at present. For example, apart from the commonest diseases, we also need to evaluate and recommend preventive measures to address pneumonia, which is the fourth major cause of death in Singapore. Sir, another example is the incidence of falls amongst our elderly. Falls amongst them not only can be fatal at times but they can invariably cause the elderly to end up requiring extensive medical care. Efforts to reduce the incidence of falls through having better campaigns, better information on how to prevent falls and better elderly-friendly environment are essential.”
“May I ask the Minister whether he would consider setting up a committee with representatives from retailers in HDB estates to look into their difficulty so that his Ministry can render them more effective assistance? BG George Yong-Boon Yeo: Mr Speaker, Sir, we have a comprehensive outreach programme right now through PSB which works closely with various retail associations and the Retail Promotion Centre. So it is not as if there is a lack of communication. There is a lot of communication. The problem is the inability of some of our retailers to make the necessary adjustment. As I said earlier, those who are prepared to make the adjustment will be able to tap upon a wide range of programmes.”
“May I ask the Minister whether the presently available Retail Operation Assistance Programme that he mentioned is successfully taken up and whether such a programme will be further improved and more aggressively promoted? BG George Yong-Boon Yeo: Since February last year, MTI has made PSB the lead agency to help the retail sector. Generally speaking, those who are interested to upgrade themselves or introduce modern methods of management, eg, franchising, inventory control, will get ready assistance from PSB. The problem with many of our retailers is that their children are not interested to join the parents' businesses. The proprietors and proprietresses themselves are not able to keep up with the new technology and so they languish in prolonged decline. These are difficult problems for us. There is really an over-supply of retail shop space in our HDB estates, and we must find a way to make it easier for them to exit their businesses. In this regard, MTI is working with MND to see how we can facilitate exit. Assoc. Prof. Chin Tet Yung: Sir, may I ask the Minister whether MTI and MND could also work together to allow those retailers who are facing difficulties in their original trade to vary their businesses so that they can take on what they regard as being more lucrative trades while they are holding the lease to such HDB retail properties? BG George Yong-Boon Yeo: Mr Speaker, Sir, over the years, we have liberalised these regulations and we shall continue to do so. We should not introduce unnecessary rigidity to industry restructuring.”
“May I ask the Minister whether the reason for the hike in specialist outpatient clinic charges is to address the cost of running such clinics or to address the long waiting times? If it is the latter, could other avenues, such as administrative policy and efficacy improvements be sought first before raising the charges?”
“May I ask the Minister whether he has a breakdown on the cost of running specialist outpatient clinics, whether the increases of charges could have been spread out in stages and whether part of the cost could have been defrayed or absorbed by the hospitals.”
“Even if difficulties abound, the desired outcome must be sought. As I have said earlier, it may involve a major change in the mindsets of both the people and the Government. We need to make a positive move to achieve this change. It would be worthwhile in the long run if the adjustments can help Singaporeans to balance the demands of work and family responsibility better. You may ask why there is such a need for us to be so proactive in promoting harmonising work and family now. Are we a nanny state? Sir, my answer is that Singapore has been successful because the Government was able to anticipate problems and influence the people at overcoming the problems. Singapore is a small country with a very small population. We cannot just let things drift unchecked all the time. In the case of declining total fertility rates, that will mean lesser and lesser Singaporeans in the future to ensure the survival and prosperity and continuity of this state. We do not have the luxury of other big countries with big populations to cushion the effect of declining birth rates. Sir, at the end of it all, if more proactive actions are taken to help Singaporeans beget happiness, as mentioned by Mr Simon Tay earlier, through harmonising work and family, our efforts today would have received its honorarium. On this note, I thank you, Mr Deputy Speaker, Sir, and the House for the patience and indulgence.”
“Sir, I would like to appeal for a reconsideration with the following viewpoints: (a) Allowing part-time foreign maids will create additional demand. This may not necessarily be so as those who have full-time foreign maids may then opt for part-time ones to save cost or to have more privacy and so on. In fact, as mentioned by Mr Simon Tay earlier, his wife is one of those who prefers part-time maid. (b) Accommodation for part-time maids will be a concern. This can be overcome by allowing only those agents that can provide accommodation getting the licence to recruit. The number of maids that will be approved will depend on the space or accommodation available for them. (c) Issue of exploitation of maids and illegals working in other sectors. Here, the agents again have to be made accountable for some code of practice to address this problem. Sir, deterrent measures can be put in place to deal with errant agents. (d) Over-reliance on foreign maids. The present rules concerning employer eligibility and maid levy may be adopted for part-time maids to prevent unnecessary and over-reliance on foreign maids. (e) Stunting the emergence of a strong domestic service sector. Sir, this is not valid because Singaporeans would not take such jobs which are considered lowly. Mr Lim Boon Heng has said that many European country families do not need maids. I would like to reiterate that these countries have good government and social support as well as conducive work environment that are pro-family. If we can match them one day in the near future, probably Singaporean families may not need maids too. In conclusion, I would say that social conditions change and it is necessary therefore that policies get adjusted accordingly to suit the needs of the time.”
“It seems, however, that principals have not taken the initiative to start later. I doubt if it is really in the interest of the students that no change in the start-times has been made, especially for the single-session schools. I therefore feel that there is a need for positive directive from the Ministry of Education on this, especially for single-session schools. On the use of Medisave for intro-vitro fertilisation, Mr Lim Boon Heng said that the Ministry of Health is currently reviewing the Medisave withdrawal limits. I hope the Ministry of Health will give a significant and favourable response on this for the following reasons: (1) The opportunity for more births; (2) Infertile couples' desperation for a child of their own; and (3) Such couples are usually young and can build up their Medisave savings for many more years. On the difficulty for young couples to rent HDB flats, Mr Lim Boon Heng mentioned existing schemes available to young couples. However, unless the couples have applied for home ownership flats under the RFS as first-timers, they are not eligible to rent HDB flats at the moment. The other HDB rental scheme available with a $800 ceiling on household income, which has been implemented for the past 10 years, invariably excludes young working couples in today's context. Sir, our existing HDB rental policy dashes our hope of changing the mindset of our young who are postponing marriage and starting family until they have succeeded in their careers or have bought their own homes. Our policy should not be hampering or contradictory in nature. Therefore, if young couples are not prepared to buy HDB homes for whatever reasons, they should not be denied the rental of HDB flats. The Minister gave several reasons against allowing part-time foreign maids.”
“Mr Deputy Speaker, Sir, I would like to thank Mr Lim Boon Heng for his favourable and positive responses. I would also like to express my gratitude to all my colleagues - Dr Vasoo, Mrs Lim Hwee Hua, Dr Tan Boon Wan, Dr Teo Ho Pin, Mr Yeo Guat Kwang, Dr Jennifer Lee and Mr Simon Tay - who have participated in this debate. They have raised many good suggestions and unique perspectives that make this debate interesting and fruitful. On child care centres, Mr Lim Boon Heng said that their studies showed a low demand for work-place child care centres overall. This is not borne out by the apparent popularity and success in the existing child care centres at workplaces run by the Kandang Kerbau Women and Children Hospital, MCDS and Ministry of Manpower, and so on. Sir, I can understand that private organisations would always consider the cost of providing child care centres. Mr Lim Boon Heng has mentioned about a critical mass for child care centres to be economically viable. However, the challenge is to re-emphasise that money spent on family-friendly practices is a draw for the company's performance and attractiveness. Steps taken by the Government to re-visit and review facilities in terms of grants, tax incentives and set up such centres will endorse this practice. Echoing Dr Jennifer Lee, Dr Vasoo and Mrs Lim Hwee Hua, I would like to suggest that the Ministry of National Development waive development charges for building child care centres at workplaces and favourably treating this as in the category of community service by our Government. On school starting later, Mr Lim Boon Heng said that schools have the flexibility to arrange their formal curriculum hours to accommodate the needs of their pupils by starting their day later.”
“This involves a major change in mindset of Singaporeans and this House needs to urge the Government for a positive move to achieve such a change. Sir, I beg to move. Question proposed.”