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?”
The complete record
Every one of 1,357 lines we hold for Lily Neo, in date order, each linked to its source. Free to read, in full, without an account. Page 23 of 28.
“Sir, may I ask the Deputy Prime Minister whether it is disadvantageous for depositors to transfer their money from the CPF to the POSBank, because, at the moment, the CPF pays more interest than the POSBank? Second, the DPM mentioned earlier that he would subvent a small group who cannot pay. May I ask the Deputy Prime Minister whether it is useful to set up, through means testing, a register of Singaporeans eligible for different Governmental subsidies so that appropriation of help can be more effectively granted to those merit cases? BG Lee Hsien Loong: Firstly, CPF interest rates are higher than commercial fixed deposit rates now. But I believe DBS has offered their package as being at the same as the CPF rate, which is 21/2%. So there is no loss to the depositors who transfer their money over. The idea of means testing so that you know who is eligible for various Government help is something which we have to study. It is not just apropos this because this is a small amount, but in general. If we want to make our assistance targeted to reach the people who need it most, then, as I explained just now in answer to Mr Simon Tay, it makes more sense to focus our attention on that group, rather than to make the whole service cheap when maybe only 5% or 10% of the people using that service are going to need the subsidy, and the rest maybe are middle or high income earners and they also benefit from a subsidy unnecessarily. So it is something which we have to study. It is not so easy to do because when you have a means test, you also have a cut off.”
“And I am sure DBS would not be the only bank which would be offering such packages.”
“One day, somebody would make an argument here that handphones are essential and should be subsidised. We have not reached that point yet. But that is the direction which we have deliberately not gone and I think it has served us well. DBS, being a commercial operation, all the more it has to break even and every proposition has to be viable. And, as DBS has explained, even if they charge $2 on these small accounts, they are not going to make money. They are still losing money. These are realities which we have to understand and acknowledge. The transition is difficult because we have become used to it. For many years, we had it for free. So now it is not free. So although $2 is not an enormous amount of money, even a bowl of kway teow costs $2, the emotional reaction is there. It is understandable. So I think it is our job to try and help to explain, and find workable solutions which will solve the problem for the long term in a proper way. The arrangement to have CPF members to be able to invest their own money with banks, financial institutions or fund management and they provide them a package of services and this $2 fee, or whatever it is, becomes just a small item because he becomes a significant customer. That is a good long-term approach because we want workers to be self-reliant, we want them to have more retirement savings, we want them to make their own decisions and judge. At the same time, from MAS' point of view, we also want the fund management industry and the banks to develop rather than have the Government to choke everything. So it is something which we can work out and, within the next six months, we would be able to work out packages and we would be able to offer entirely reasonable menus.”
“There is an interest in promoting savings and thrift, and in encouraging particularly children, and servicing national servicemen. But it has to move to a commercial basis of operation. So the services will be charged properly, but they will be affordable. DBS makes so much money. Why cannot it just absorb it? You can ask: the Government makes so much money, why cannot it absorb this? The reason the Government is not broke is because we are very careful with our money and we only spend it when there is a strong merit. And similarly, with DBS, or any other commercial operation. Every proposition has to be viable. DBS earns a profit. Is it humongous? Well, it is bigger than it used to be. But if you look at the return on equity, it is below 10%. It is not a respectable return. Mr Jeyaretnam just now had an argument with Dr John Chen as to why bus companies need to earn respectable returns. All corporations have to earn respectable returns. That is the way the market works. If there were no returns, why should anybody buy DBS Bank shares? Why should DBS be in business? If it is a Government department providing a service which is absolutely necessary, and which provides returns to the whole society, like education or public housing, then we say, yes, we subsidise. If it is a service which is provided to a person, or a family, and the family needs it and benefits from it, it may be essential, but our philosophy is, better let the service be priced, be charged, the family can pay. Because the economy is properly structured that way without distortions and subsidies, there are jobs, families have opportunities, they can earn income, and so Singaporeans can pay their PUB bills, SingTel bills, even handphone bills.”
“May I ask the Deputy Prime Minister whether our Government is still recommending that POSBank upholds its people's bank concept, or was that concept dispensed with when POSBank merged with DBS? Why is it that a hugely profitable bank, like DBS, should not absorb what seems to be a negligible cost? BG Lee Hsien Loong: Mr Speaker, Sir, first of all, the people's bank is an emotive idea. The only bank which is called a people's bank that I know of is the People's Bank of China and it does not take small deposits. Banks have to break even. POSBank has to break even. For a long time, it was able to do so by cross-subsidising from the big accounts to the small accounts, paying big accounts less interest, providing the small accounts services for free and absorbing the cost, and Singaporeans tolerated it out of habit. They banked with POSBank for many years, they continued to do that. But Singaporeans nowadays, as MPs will know, are very sharp, pencil-sharpeners. They calculate exactly where their money goes, how much it is earning and they want to put their money to work for them. So POSBank was finding that by offering bigger deposits less interest, it was losing deposits. Singaporeans would say, "You may be tax free, but I have made my calculations, and I am going elsewhere. Never mind the tax, I get better service, I get overall better return." So POSBank was reaching a position where it was unable to continue with these free services and, as I quoted Tan Cheng Bock and other MPs too who spoke, for many years, POSBank has been pondering this problem, what to do about it and how to introduce charges in a way which is acceptable. Finally, we decided better make a break, and transferred it over to DBS Bank. There will be a transition.”
“May I ask the Parliamentary Secretary whether his Ministry will inform all doctors on the need to verify work permits of maids for identification prior to consultation and certification in their clinics? Am I correct to say that there are employers who are reluctant to hand work permit passes to their maids? Therefore, the requirement for the Ministry to verify the identity of maids will help doctors enforce the correct procedure.”
“May I ask the Parliamentary Secretary: in a case of deceit by the maid, is the doctor still to be blamed or is the maid solely liable?”
“May I ask the Parliamentary Secretary whether it is correct to say that there were cases of false negative findings in patients not due to errant doctors but due to the deceitful acts of maids in adulterating urine samples and in using someone else's urine samples for examination.”
“Sir, may I ask the Deputy Prime Minister whether there is a need to have a control on margin requirements presently or in the near future in Singapore? BG Lee Hsien Loong: Mr Speaker, Sir, it is standard to have margin requirements, because we want to make sure that individuals do not over borrow, and that if the share prices go down, they are actually able to pay for it and do not default. And we also want to make sure that the intermediaries, like the brokers and the banks, do not over lend. Because if there is a default, it is not just the individual customer's problem or the individual broker's problem, but it could become a systemic problem, as Members will remember from Pan Electric. When Pan Electric went bust, a lot of brokers found that they had over extended themselves and several went out of business. We had to organise a life boat fund to try and rescue the rest, which we succeeded in doing. So there is a need for margin requirements. The question is how strict they should be, and how they should be applied, and what we should do with brokers and non-brokers. These are things which we are studying now.”
“Sir, may I ask the Deputy Prime Minister whether the new financing by financial institutions has aggravated the stock market fluctuations in Singapore recently? BG Lee Hsien Loong: Sir, I doubt it, because I do not think the volume is very large. It is only about 1% of the stock market. So it is unlikely to have a major impact.”
“Has the Ministry done any studies on problematic students in Singapore because such studies will help us in planning for the future policies and preventing us from having such children?”
“May I ask whether the Ministry of Education would have any more steps taken to further improve the moral and good values of our students? Secondly, is there any system in place in the school where the teachers are able to actively diagnose high risk students?”
“Has the Ministry of Education done any studies on these problematic students thus far, to find out the underlying problems in them? Could the Ministry of Education help those students who are predisposed to these problems and take a more proactive approach to prevent the ill effects? Sir, it has been said that every Singaporean counts. This being so and since some kids need more attention than others, would the Ministry of Education not have to allocate more time and effort for these high-risk students? It would be good if the Ministry of Education could collaborate with parents, voluntary welfare organisations, self-help groups and more professional counsellors. Sir, may I ask the Minister for Education whether he needs to review the discipline meted out by schools in view of the increased rate of offences committed by secondary school students, especially female school students? Should the schools not use more mentors and role models to lead the pupils? Could the Minister consider self-esteem courses for secondary school students? Sir, it will be good to teach children how to empower themselves to succeed in life through a correct understanding of one's self worth and through one's core values. A lot of delinquency and gangster issues stem from lack of self esteem. Gangs provide the security and status that the delinquents do not have due to their family situation. Employment of external organisations to facilitate this may be helpful. I know that some schools have engaged outside parties for this purpose. Perhaps this should be put in as a core non-academic curriculum. Sir, I hope the Minister for Education could enlighten me on these issues I have raised.”
“Sir, there have been many reports in the media these days regarding the deterioration of family values. There have been reports of acts of atrocities between teenagers, gang fights amongst teenagers, abandonment of babies by teenagers and so on. I know that families have the responsibility to imbue the right values in their children and to discipline them when necessary. It is acceptable to argue that the teachers in schools can only do so much. However, I would like to beseech the Minister for Education to reassess this area to see how the Ministry of Education could chip in here and nip the problem in the bud before things get out of hand. Although the school's main task is to impart skills towards academic achievement, all the efforts will be wasted if moral values deteriorate further. I hope the Ministry of Education will consider the teaching and observance of moral and good values in life as an integral part of education. The teachers in schools are in an extremely good position to diagnose early symptoms of delinquency in many cases, as students do spend a lot of time in school. There are many full school days, especially for secondary students, and the teachers are in a lot of contact with their students. The schools should be able to identify at-risk children and either alert their families or any organisation or community. Sir, the reason for the deterioration of family values in many instances is due to underlying faults within the family unit or to lack of discipline at homes. These trends may be on the increase with more broken homes and increased divorces. The lack of discipline is compounded by the norm of the dual income families of Singaporeans with two-child families or less.”
“May I ask the Minister on the multi-service centres. What kind of fund allocation has been provided for them? Earlier on, the Minister might have got me wrong. I did not ask for such centres to be set up immediately island-wide, but could I just have the timeframe of what kind of numbers will that be in the end.”
“Governmental financial subsidy, of course, has to be forthcoming as the elderly usually have no disposable income to pay for these services. I hope the Minister for Community Development will take into account all the points raised when implementing these "multi-service centres".”
“It is better to strive for excellence in this area so that we do not need to cater excessively to look after the sick and disabled elderly. I urge the Minister for Community Development to first prioritise setting-up such basic centres which are easier and cheaper to run. Once we have such centres in place, other relevant services, including childcare, can be developed from them. 1.15 pm Sir, the Ministry of Community Development should not be over-zealous in getting co-location of other services too quickly in the "multi-service centres". Let there be well-founded basic centres in the beginning and expand to have other services from these centres later. The expansion for other services is best tailored to the requirements of each centre or the task may be overwhelming and prone to failure. It is to be noted that a constituency that needs eldercare may, indeed, not need childcare services, and vice versa, depending on the age distribution of the residents. These basic centres will be good platforms to offer help on various aspects, such as health, finance or job issues, to an ageing population. They can also be further developed into day rehabilitation or day care venues and some of the healthy elderly there can even be co-opted to help and care for the dependent elderly. Sir, as recommended by the Inter-Ministerial Committee, it is best to set up the "multi-service centres" through the collaboration of the Ministry of Community Development, the Ministry of Health, the Community Development Council and the grassroots and voluntary organisations. We should make use of available infrastructure like the community centres that are often under-utilised in the day as the centres.”
“Sir, the Inter-Ministerial Committee on the Ageing Population has many good recommendations on how we can prepare Singapore for an ageing population. I would like to urge the Minister for Community Development to hasten implementation of some of the recommendations and to ensure attainment of those recommendations. I would like to raise the issue of community-based services for our senior citizens. Here, I strongly agree with the Inter-Ministerial Committee on the Ageing Population on one of its key desired outcomes for senior citizens, and that is, to ensure sufficient opportunities for healthy senior citizens to remain socially, physically and mentally active. Indeed, I have been advocating this and have mentioned this in this House on several occasions. Setting up "multi-service centres" and integrating health, social and other services under one roof for senior citizens has been recommended. Two models have been suggested: (1) co-location of services targeted at different clientele groups such as senior citizens, children and disabled, and (2) co-location of eldercare services such as day care, day rehabilitation and home care. I would like to reiterate that for this scheme to give the best results in the future, we must first have basic centres preferably throughout the island that promote the social, physical and mental well-being of the independent elderly. The aim of the centres is to enable the elderly to lead a healthier, happier and independent life for as long as possible and to contribute to society for as long as possible without burdening themselves and others. Sir, the very basis of preventive care for the aged shall depend on a scheme like this.”
“Many "step-down care" patients need continued medical care and long term medications after their discharge from the hospitals. If the medical expenses are exclusive of the "step-down care" and are excluded from financing, this financing scheme will only fail. Sir, our future cases of chronic-disease sufferers will heavily burden our tertiary medical institutions, raising the healthcare costs unnecessarily when they can be cared for in the community facilities or in their own homes. But they will opt not to because they can only use Medisave and MediShield in the tertiary institutions and not at community facilities or when they stay at home. I hope that we do not let this serious mistake take place, or we will have a perpetual flaw in our system. I hope the Minister for Community Development can steer the implementation of this issue with favourable outcome.”
“Sir, I have repeatedly raised in this House, over the past three years, various issues about the aged in our country. Notwithstanding the embarrassment of being a bore to my colleagues, I seek their indulgence on this topic one more time. Please allow me to reiterate an important issue concerning ageing of the population. I refer to the financing of healthcare for senior citizens in the future. I am raising this issue under the Ministry of Community Development because it is the lead agency to implement the recommendations of the Inter-Ministerial Committee on Ageing Population. As I have mentioned in this House before, there is an inadequacy in our present healthcare financing in spite of our Medisave, MediShield and Medifund schemes. This was recognised by the Inter-Ministerial Committee on Ageing Population and is referred to as "Expanding Step-down Care Financing". It is recommended that the Ministry of Health and the Central Provident Fund Board establish, as I have advocated in this House as well, an insurance scheme against severe disabilities. It is also recommended that the premiums be made less burdensome by making it payable with Medisave. Sir, my main contention on this issue is that we must make sure this insurance scheme addresses the problem well and its execution is well planned, lest we find it still lacking after implementation. In order to ensure success, this insurance scheme must cater for all aspects of "step-down care" and contrary to the recommendations of the Inter-Ministerial Committee on Ageing Population, must include medical expenses. Yes, coverage of medical expenses is an important part of "step-down care" and must be included.”
“The tangible benefit for a lot of households, as many households have at least one person above 50 years, will be good for our nation too. The CDCs are the best to carry out this programme because it has the machinery of the grassroots workers to ensure comprehensive coverage of residents in the constituencies. The Ministry of Health shall lend the medical resources and the follow-up of patients that require them. (2) Sir, the second area that I would like CDCs to consider is the complete take over of MediFund and the future ElderCare Fund. CDCs should be the decision-making body in the disbursement of these Funds because, as "local councils", they will know the residents' needs better. The grassroots also have better rapport with the residents in assessing the eligibility of the applicants. This is better than letting social workers of the hospitals to do the job. Members of Parliament can be the advisors and perhaps hand out the awards to the residents. (3) Sir, as we are facing a fast-increasing aging population in Singapore, I would like to urge CDCs to redouble its attention in these potential problems that come with it. The CDCs should consider setting up and subsidising Centres of Activity for Retired and Elderly (CARE) island-wide. These centres are to make sure that the increasing numbers of elderly have places to go to every day where they can have beneficial physical, mental and social care. The purpose is to maintain them to be as healthy and active for as long as possible. The elderly who attend these centres will appreciate the effects and their children will have peace of mind knowing that they are catered for while they are there. Sir, I hope the Minister for Community Development would consider my suggestions.”
“Sir, I am very glad that this Government has set up Community Development Councils (CDCs) to more effectively cater to the needs of the people. I am concerned about the direction the CDCs should go in order to be relevant and perceived as relevant to our citizens. I would like to suggest that the CDCs should be proactive in areas that affect a majority of residents and on programmes that benefit more residents in the constituencies. Ideally, the CDC can be a form of "local government". I would like to suggest that the CDC also venture into three areas that I am familiar with; areas where most families will benefit from and can appreciate from long-term outcome. These areas are: (1) Healthcare is generally an important issue to most people and, frequently, it is a political one too. Singapore is no exception. It is, hence, an area worthy of the CDCs' attention. A programme that can benefit all the households of our residents and also something that will improve the health of all the residents would hold the CDCs in good stead. I am suggesting that the CDCs sponsor everyone above 50 years of age for health screening tests on a regular basis. The Minister for Health announced yesterday on the launching of a community health screening programme. The CDCs could perhaps co-sponsor this scheme for residents on the amount payable by them, especially those less well off residents. Sir, this has the benefit of making sure that preventive care is extended to everyone, especially to the poorer and less informed. This will ensure that Singaporeans will have better health and happier lives. It will thus help in containing the cost of healthcare in the future as well as in enhancing the economic contributions of a healthier citizenry.”
“Many families make use of childcare centres and the children spend long hours in the centre. It is therefore important that the centre is able to provide a nurturing and stimulating environment for the children. Recent research has shown that the early years of a child's development is crucial and can have a long-term impact. This adds to the need to focus attention on this area. Since the Ministry is raising the standard of the supervisors, is there any plan to gradually improve the standard of the childcare teachers and to raise the standard of service? Sir, I am aware that the Ministry has licensed childcare centres for many years. With increasing evidence that the early years of development are important, what other measures the Ministry has taken to ensure that the children are given good care in our childcare centres?”
“May I suggest that the Government allow privatisation of the VWO childcare centres? The Government could instead subsidise the more needy end-users. A "means test" could be applied. The Government should have a hands-off approach in the actual setting up or running of such centres. Let more private organisations run such centres. The Government should just confine to stipulating certain basic requirements to ensure standards and conformity. Some may cite the fear of escalation in the prices charged by VWO childcare centres as the stumbling block for such an idea. Sir, this fear will be unfounded when there is competition and prices are reached through market forces. Furthermore, the Government can still control the market through planned release of permits or premises for childcare centres. Sir, I hope the Minister for Community Development could give us a favourable response to my above-mentioned requests. Dr Ho Tat Kin: Sir, currently, there are 532 childcare centres providing service to more than 33,759 children. With so many childcare centres set up by different organisations ranging from VWOs to profit-making entities, there must be a variation in the standard of service. While there are MCD guidelines on the physical standards of the childcare centres, there are variations in the service provided by the childcare teachers. Has the Ministry done any studies to profile the different standards of service and try to normalise the standards? In October last year, MCD announced that in five years' time, the qualification requirement for supervisors of childcare centres would be raised from the current advanced certificate level to diploma level. I support this move by the Ministry to raise the quality of care which children receive in the childcare centres.”
“Sir, building a cohesive and resilient society by fostering strong and stable families is one of the missions of the Ministry of Community Development. The way MCD aims to achieve this target is to try and reinforce the value of marriage, procreation and family. As dual-income families have become the norm in Singapore, childcare issues have also become an important component for the MCD and its mission. I would like, therefore, to raise the following issues in this area. Sir, we have a shortfall of about 20% of childcare centres at the moment. Some popular centres have, in fact, an uncomfortable waiting list of a few years. What are the steps taken by the Ministry of Community Development to address this shortfall? Could the MCD rectify this shortfall as soon as possible? New and densely built condominiums with many young families are the ones that need childcare centres the most. Disappointingly, they are the ones that have no childcare centres within easy reach. Residents of new HDB flats have to wait quite a while to get their centres. Could the Ministry of Community Development have better provision and planning, in collaboration with other relevant Ministries, so that sites for childcare centres for both the private and HDB estates can be designated? Sir, I hope that when it comes to national issues like this, the Government will not aim to cater only for the public housing residents. The Government should provide for all Singaporeans to reinforce the values of marriage, procreation and family. Sir, some private childcare centres are doing very well and are in great demand. However, many VWO childcare centres cannot do as well, because they are stifled by Government's intervention in "fees fixing".”
“Would the Ministry of Community Development, in collaboration with other Ministries, for example, Ministry of Manpower, facilitate the option of job sharing? This has worked well in other countries and a significant number of working mothers job shared effectively. Could we also look at more opportunities being made available for working women to work from home either on a part-time or full-time basis? Yet, another consideration is for the Government to approve paid leave for a parent to care for sick children. This should apply equally, both to a mother and to a father, and this will be a strong signal from the Government in encouraging the equal role of child parenting in our families. Sir, I hope the Minister for Community Development could consider these issues and help us have our families strong and stable.”
“Spouse support, both physical and emotional, is therefore a vital recipe for working women to cope better and a formula for a successful marriage. The Ministry of Community Development should steer a campaign on this issue urgently and successfully. Childcare is always an essential consideration for many dual-income families. The Ministry of Community Development should therefore continue to provide for more childcare centres. Could the Ministry of Community Development also provide other new childcare assistance initiatives such as "share-a-maid" and "borrow-a-granny" schemes? Sir, with the "borrow-a-granny" scheme, a retired but well and able elderly baby-sits on an ad-hoc basis for other residents in their constituency. Such a scheme is best operated from our Centres of Activity for the Retired and Elderly where there are many suitable elderly who may be willing to render such a service. Sir, it will be beneficial if the Ministry of Community Development and the Ministry of Manpower work closely to facilitate flexible work arrangements for working women. The Government may consider providing more incentives to encourage this arrangement and to ensure its success. Employers should be encouraged to transform part-time work from being temporary and casual in nature to that of a permanent scheme, in terms of job security, remuneration, benefits, training and promotion prospects to the part-timers. Another area that is worthy of attention is job security while families are pursuing procreation. Could the Government persuade employers, maybe in the form of certain incentives, to allow women to take longer unpaid maternity leave (up to one year) to care for their infants?”
“Sir, the dual-income families are a normal phenomenon in Singapore these days and female workers account for about 40% of our total workforce. The contributions of women to their families and to their country are indeed substantial. A majority of our working women are holding full-time jobs, just like our working men. But women continue to bear the primary responsibility for family and childcare tasks. Studies have found that women in dual-income marriages encounter more role overload than their husbands. Working mothers, who are torn between the demands of home and the workplace, are sometimes troubled by problems such as unsupportive and demanding husbands, and rebellious and wayward children. On top of all these family problems is job stress. Sir, I would like to beseech the Ministry of Community Development to look at the help that can be rendered to our dual-income families to support them. If we can be successful in this area, we will be able to ensure more ideal families, especially in areas of stronger marriages, better procreation and stable families. It will be best if the effort in this area is done jointly by the Ministry of Community Development together with other concerned Ministries. Sir, it is very important that we encourage a change in the mindset of many Singaporeans. Husbands cannot depend on their wives to care for the entire household and parenting tasks and, at the same time, bring in additional income for the family. Many men see participation in household tasks and child rearing as a threat to their masculinity. There was one Aryee's research in 1992 in Singapore that found that job-homemaker conflict experienced by professional women in Singapore is significantly reduced when the husbands contributed more hours in doing housework.”
“Sir, I would like to seek a clarification from the Minister. Earlier on, the Minister said that the long-term disability insurance would not cover chronic diseases. May I ask the Minister: are we not leaving a crack in our financing system in medical care because chronic disease sufferers in the future will be flocking to our hospitals as these are places where they can get paid through Medifund, Medisave and Medicare?”
“Long-term financing must be made available to address this area, and to facilitate care of patients outside the hospital setting as well. We must seriously consider implementing one of the most effective ways to cater for the chronic sick in the future. This is to get the primary healthcare doctors to care for the chronic sick, as much as possible, without hospitalisation. There must be greater integration between the public hospitals and primary healthcare doctors in the private sector. Sir, I would like to declare that I am a private general practitioner. Encourage shared care and step-down care to the primary medical practitioners, and we will certainly reduce the use of acute hospitals and community hospitals. Most patients will also benefit when they can stay at home and close to their own families. Sir, I would like to suggest that chronic healthcare requires that a standard protocol be put in place for chronic illnesses in terms of long-term healthcare financing. This will ensure better treatment for all the chronic cases. This will also ensure conformity, in terms of care, to all conditions. Patients can also have the assurance that they are given the best care as recommended by this protocol and follow-up wherever they seek treatment. For example, in the care of diabetes, the protocol on the frequency of blood check-ups, eye testing, ECG testing and so on must be determined. I would also like to suggest that the Ministry of Health make it easier for face-to-face discussion of patient care between doctors in the public and private sectors. This will be especially useful in the shared care and step-down care of chronic cases. Sir, I hope the Minister for Health could enlighten me in the issues that I have raised.”
“Sir, Singaporeans are living longer now with an average life span of about 78 years. This is expected to improve further with newer medical advances. As our population will age at an exponential rate, there is an urgent need for the Government to cater for the requirements of long-term healthcare of many more people who have chronic diseases due to chronic illnesses such as diabetes, hypertension, cardiovascular diseases and so on. It is of paramount importance that we address these issues quickly so that we have a well-planned medical system in place to cushion the burdens of long-term healthcare. Sir, there are three areas that we need to consider here: first, is the financing of long-term healthcare; second, is the medical care to best cater for long-term healthcare; and, third, is the provision of tertiary care of long-term healthcare in hospitals. On the financing of long-term healthcare, I have raised in this House more than once the issue concerning the inadequacy of the present "medi-plans" for elderly Singaporeans for this purpose. I have suggested that perhaps another insurance scheme, say, "Medicare" - a patient-Government co-payment scheme - may fill this inadequacy. Sir, I am delighted, therefore, that the Inter-Ministerial Committee on Healthcare for the Elderly has recommended an insurance scheme to solve this problem. The success of long-term healthcare will be based on the basic tenet of promoting preventive care to prevent complications of chronic diseases. In other words, help patients to care for their chronic diseases as best as can be, so that with lesser complications, they can lead a better life with less pain to bear physically and financially.”
“We must always remember that the morbidity and mortality from any disease can be dramatically reduced when the diseases are treated in their early stages. (5) The most important item to success is the allocation of adequate funds for preventive healthcare. The dollars allocated for preventive healthcare programmes today will enable our people to lead healthier and happier lives, and also save us the heavy expense in building more and more nursing homes and hospitals. Sir, I am sure the Minister for Health will have the rightful considerations for this concept and apportion due importance for it, so that we can have a lasting legacy for a better life in Singapore.”
“45 pm (2) The other important tool to ensure the success of preventive care is to get all doctors throughout the island, not just those in public institutions but also all those in private practice, involved in the whole concept. The Ministry must, therefore, find ways to engage all our doctors in all the different aspects of preventive healthcare. Furthermore, we should encourage all our doctors to be mindful of the need to promote preventive healthcare and to be committed enough to consistently influence their patients on the value of preventive healthcare. (3) Sir, a more integrated approach, with the involvement of the community, grassroots organisations and voluntary organisations, will help in the implementation of preventive healthcare. The involvement of immediate family members with regard to preventive healthcare for their aged parents is another important area that should be pursued. (4) A "Department of Preventive Healthcare" of its own should be set up in the Ministry of Health to ensure continuity and lasting follow-through of all efforts on preventive healthcare. It will be the department's job to continuously identify prevalent diseases that can be given greater attention, and to continuously monitor and study the trends for prevention of common diseases as well as the many different aspects of preventive healthcare. Some basic tenets of preventive healthcare make it necessary to adapt constantly. For instance, whilst it would be impossible to try and prevent all cancers on an equal basis, we should pay more attention to the more prevalent and devastating cancers in Singapore. We need to make sure that essential preventive healthcare programmes are geared to reach the at-risk folks at the local community level.”
“Sir, "prevention is better than cure" is a fact that each one of us here would accept wholeheartedly. In fact, my parliamentary colleague, Mr Yeo Guat Kwang, had just reaffirmed this. I beseech the Ministry of Health to establish firm directives on promoting preventive healthcare. The successful implementation of preventive healthcare will translate into quality life for our people and the enormous savings for the people and the nation on healthcare cost. Sir, I have spoken on this important issue several times in this House and also have moved an adjournment motion on it not too long ago. I would like to re-emphasise that the core directives to ensure success of preventive healthcare are as follows: (1) The Ministry of Health must campaign for a mindset of acceptance in the age-old dictum - "prevention is better than cure". Many Singaporeans still believe in seeking for remedy only when they are sick, and in many unfortunate conditions, it is too late. An example of this is when they are seeking the remedy for renal failure due to the end-disease of untreated diabetes or hypertension. If we can succeed in persuading people to look after themselves better, half of our battle is won. The Ministry of Health should therefore step up health education about healthy living and on responsible awareness and care for one's health. Excessive campaigns, with effective use of television media, may make the people more responsive, especially when they realise what the end-results of many uncontrolled common diseases are. Sir, do not let the lack of information to the people cause efforts on preventive healthcare to fail. 1.”
“The advantages of such schemes would be the significant savings on cost, the decreased demands on the hospitals in terms of beds and medical staff, and more importantly, the positive effects of having patients continuing to stay in their own homes with their loved ones. Preventive medicine, as the key towards maintaining good health in any population, cannot be over-emphasised. This therefore is one area we can ill-afford to cut back on. Instead, we must seek out all avenues to help the healthy maintain their well-being for as long as possible. In the long run, it will be the ministry of continuous and concerted efforts in promoting preventive medicine that would contain the escalating costs of healthcare. The involvement of the primary care doctors in this, with the encouragement from the Ministry of Health, will be the way to go in promoting this important area of healthcare. The Ministry should devise a plan to maximise the relationship of doctors and patients in this aspect. The availability or the convenience of the geographically placed private clinics will be an advantageous asset for success. Sir, the primary healthcare doctors usually have better rapport and more time with the patients. They are therefore ideal for promoting preventive healthcare, especially so when patients give scant thought for preventive care or routine medical check-ups when they are not sick. We have to change the mindset of people and reaffirm the idea that prevention is better than care. The Ministry of Health would be doing well if it could get one and all to go for preventive healthcare. Sir, I hope that the Minister for Health can enlighten us on my proposals.”
“Sir, Singapore has a quality primary healthcare system that is also very affordable. However, I feel that we can still tap our resources and better the potential of our existing system for the benefit of this nation in the future. I would like to suggest that we look at the following areas to bring our primary healthcare to even greater heights. Sir, at this juncture, I would like to declare that I am a general practitioner in private practice. The private medical practitioners should remain the main providers for primary care. At the moment, they provide primary healthcare to about 80% of the patients. But they should be more involved in step-down care from the tertiary and secondary institutions. Sir, we need to look for more practical and prudent ways to integrate and tap all sectors of our available healthcare facilities. The Ministry of Health should devise a scheme to encourage this, especially in terms of shared care and step-down care. This will save a lot of wastage on the more expensive facilities and medical personnel in our public hospitals. Moreover, when these patients are transferred to primary care, they also benefit from the lower costs, the convenience of seeing doctors near their homes and the luxury of staying in their homes with their loved ones. This will spell efficiency at its best. We should induce the primary level care providers to cater for the increasing numbers of the elderly and the chronic sick. Perhaps, they can work more closely with the hospitals in shared care schemes. The Government can remunerate them in a reasonable and controlled manner so as to ensure affordability.”
“There are private doctors who are willing to come to the public sector on the same remuneration as the public doctors, if given the chance. Turning to doctors in public hospitals, integration would mean the chance to practise in the private sector in whatever form that is evolved in time. Of course, the Ministry can always specify that only those who have attained a certain degree of seniority and expertise are eligible for such options. The effect of this would be: (1) The eventual establishment of a pool of doctors that is in a continuum of movement in and out of the two sectors. In fact it would be all the better if there is mandatory movement of senior doctors to the private sector. This would make the prospects of promotion and progress of junior doctors more attractive. (2) Now, the integrated system would have the doctors eventually coming back into the public sector. The constant hassle of the exodus of doctors from the public to the private sectors would be curtailed. Sir, the details for a fully workable model for all this to work can be worked out and in due course a truly integrated system of healthcare can be evolved. It is my hope that the Ministry of Health will look into this issue on doctors and implement the necessary steps.”
“Sir, I would like to urge the Minister for Health to look towards the greater integration of our public and private medical sectors concerning doctors. I would like to declare that I am a doctor in private practice. The doctors in the private sector are not tapped to the fullest potential. The doctors in the public sector are not exactly content with their lot. Sir, we need to soften the divide between the two sectors for the better of all concerned. Let us first consider the case for doctors in private practice. It will be advantageous if we can have them contribute to the public sector. The most overt effects of such a situation would be: (1) The reduction of the very heavy workload of doctors in the public sector. We can revamp the present "visiting consultants" scheme and implement a structured permanent scheme for private doctors to contribute to patients in public sector positively. At the moment, the existing consultant scheme is only a token. A comprehensive type of contribution is not possible perhaps because the agenda does not call for it. It is not implemented wholeheartedly and this scheme is not very successful because there may be distrust and fear amongst doctors regarding motives and vested interests. Private doctors have to depend on the friendship and courtesy of their colleagues in public hospitals to be offered "visiting consultant" posts and, even then, some may still feel redundant and unwelcome. Sir, a new scheme should be in place to allow private clinicians to come back either part-time or full-time in the public hospitals. (2) Many private doctors are more than willing to serve subsidised patients and to teach in the public hospitals given the opportunity.”
“Capitalising on existing equipment that is available and much too under-utilised in the private sector should be made available to the public sector and vice-versa. Patients from the public hospitals may not be able to afford the cost for using such equipment in a private set-up. Sir, this can be overcome if the private set-up weighs its options of leaving the equipment to stand idle or of letting the equipment be used by the public hospitals at special (out-sourced) rates. Bulk order of standard requirements of hospitals and clinics, like catheters, needles, sutures, medicines, and so on, jointly by all medical estalishments, makes good economic sense. When the lowered costs are made available to all medical establishments, including private clinics, all patients will benefit. They get to pay less for their treatment and general expenses. The savings in cost can amount to a few hundred dollars, a 50% reduction at times, for some patients each month. Another example of useful area of cooperation through integration is a centralised sterilisation for all medical establishments. This is one area worth considering. Sir, I hope the Minister for Health would consider my aforesaid suggestions.”
“Thank you. Sir, I would like to urge the Minister for Health to look into greater integration of the public and private medical sectors concerning medical establishments. I would like to declare that I am a general practitioner in private practice. When the Ministry of Health is able and willing to treat the private hospitals like "private wings" of restructured hospitals, and use the multitude of general practice clinics as extensions of polyclinics, integration in a lateral manner can become a reality. This would involve a fairly major mindset change by all the relevant people in our healthcare institutions. Sir, lateral integration of all the medical establishments in Singapore will be a good thing and I would like to point out some of the advantages that we may reap. An area of benefit from integration between public and private hospitals and clinics is in the "shared use" and "free flow" of available personnel, especially in those areas where there is a shortage. This will save cost as the integration and cooperation minimises expensive training of more and more people. This will maximise our efficiency and enable optimum use of our resources. The savings can then be passed on to the patients. Sir, another advantage of integration is in the shared use of expensive equipment in both the private and public sectors. There is a need for better planning and collaboration in this area between these two sectors. There are many instances where it makes no economic sense to support two expensive machines, such as 4 million-dollar a piece PAT-Scan or Positron Axial Tomogram Scan in both the private and public sectors. We do not have enough users to justify the availability of more than one scanner.”
“Sir, I hope the Minister for Health could consider my proposal. Sir, may I now go on to my next amendment on medical establishments?”
“Sir, the study concluded that the economic cost of asthma is considerable and justifies the need for a concerted effort to reduce asthma morbidity. This is especially so with such prevalence in children. Asthma is an eminently treatable condition with good evidence that newer interventions and adherence to treatment can be cost-effective in the long run. Studies in Singapore have reflected sub-optimal management of asthma in the community; this area will benefit from a national health programme. What is required is a Comprehensive Asthma Programme, aimed at reducing asthma mortality and morbidity at all levels of the healthcare system, with the long-term goal of improving the care of asthma cost-effectively. Sir, there is a need to make asthma a healthcare priority, in the same league as other common diseases such as cardiovascular disease, cancer, stroke, hypertension, diabetes, etc. The school environment is particularly important to children with asthma because acute exacerbations can lead to decreased ability to concentrate, decreased participation in activities, and high rates of absenteeism. Sir, identification of children with the disease, communication with parents and health-care providers, removal of triggers in the immediate school environment, and maximisation of access to medication when needed are all key factors in managing the disease. We can tap the expertise of the doctors from the Singapore Asthma Association to train teachers to handle asthma in schools. In order to significantly reduce asthma morbidity, an integrated approach is required, involving individuals from a broad range of backgrounds and interests. There is also a need to coordinate the efforts of such individuals and institutions involved in asthma care.”
“Sir, more national health programmes must be introduced to highlight the prevalent illnesses in Singapore, especially those that will benefit large numbers of sufferers. One good example that has been neglected in this respect is the very common condition of asthma. 1.00 pm In Singapore, asthma is a highly prevalent problem, seen in 5% of the adult population. In a study that examined the healthcare, utilisation patterns for asthma in Singapore between 1986 and 1993, asthma was ranked 5th among principal conditions with the highest number of discharges. Among 0-14 year olds, asthma was ranked second, only after accidents and injuries, as the condition with the highest number of discharges. It was estimated that there were approximately 20,000 accident and emergency (A&E) room visits for asthma per annum. In the primary healthcare setting, asthma ranked 6th among leading conditions seen by the general practitioners and Government polyclinics. Among under-15 year olds, asthma ranked as the second leading condition, behind upper respiratory tract infections. Sir, this study showed that asthma is a significant cause of morbidity in Singapore. As in many countries, there has been a marked increase in the prevalence of childhood asthma over the past 20 years. It is estimated that 140,000 individuals have current asthma and more than 100 individuals die of this disease annually in Singapore. There is also a substantial degree of under-recognition of asthma among school children in Singapore. A recent local study estimated the economic cost of asthma, both direct and indirect, to the patient and community. The total cost of asthma in Singapore was estimated to be more than US$30 million per annum.”
“I will clarify. Certain practices surely must be based on criteria that are sound. Therefore, all the policies that are being adopted by the Ministry of Health should be based on certain basic principles and one of which, of course, is cost efficient and effective medicine. Are we not using our national funds and public funds unnecessarily?”
“Sir, could the Minister assure this House that he will ascertain that there are no inappropriate practices existing in the hospital now, and whether he could avert other unhealthy policies in the future, basing it on the fact of cost efficient and effective medicine?”
“Sir, the Minister said earlier that he agreed with me. Does it mean that he is going to stop this type of referrals to the specialist outpatient clinic now?”
“Can the Minister be more explicit in his reply, Sir? How do we expect patients to know the severity of their illnesses to warrant specialist care all the time if we just allow them self-referrals?”
“Mr Speaker, Sir, I think the Minister did not get me correctly. I did not mean subsequent check-ups with the specialist where they can go back any time. I am talking about first-timers who just call up the outpatient clinics for an appointment and they just walk in to see the specialist.”
“Would the Minister condone such referrals? Would not such referrals to specialist outpatient clinics cause an inappropriate use of medical facilities, and tax our public hospitals unnecessarily and frivolously?”
“Mr Speaker, Sir, I would like to declare that I am a doctor in private practice. May I ask the Minister why specialist outpatient clinics take appointments from any patient who so wishes through the phone and without any referral? Would not such practice run counter to the basic tenet of cost efficient and effective medicine? Surely not every sickness needs the care of specialists?”