Lily Neo
Singapore
“Thank you, Mr Speaker. May I ask Minister for Health on MOH's capacity in coping with serious cases of COVID-19 in terms of adequacy in respirators and in our ICU beds. Am I correct to say that already half of NCID's ICUs are taken up? What will happen when it reaches its full capacity?”
“But even so, with the right measures of social and medical assistance in place to assist them with their daily living, they can still age gracefully in the comfort of their own homes.”
“Thank you, Mr Chairman. Yes, I will keep it short. Minister earlier said that MSF will proactively reach out to families in HDB rental homes to assist them, to possibly buy their own HDB flats. Many of these families lamented that they cannot afford it. How does the Minister plan to do it?”
“Thank you, Mr Chairman. May I ask the Minister whether there is a possibility of more widespread community spread of COVID-19? And will MOH be able to cope with this? And whether does our Government have more specific measures in place to cope with this scenario?”
“Thank you, Mr Chairman. Earlier in my speech, I asked whether there are assessments by HDB for applicants of Joint Singles Scheme (JSS) to ensure that they are free from mental illnesses and medical conditions before compelling them to stay together.”
“Many of them have lived in rental housing for more than six years and some more than 10 years. Thus, there are signs of entrenchment. What are the schemes in place and the success rate of such schemes, to assist them in looking for better options in their housing needs and to help them get out of their predicaments?”
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“Sir, may I ask the Minister what is the timeframe for his consideration?”
“Sir, may I ask the Minister whether there are enough geriatric departments in our hospitals to service the elderly patients at the moment? And should we not increase and prioritise this area of health care in view of the fast increasing numbers of the elderly in Singapore?”
“However, if it is intended to be a collective punishment, then the partnership or body corporate be punished and not the individual. Sir, I support the Bill.”
“Mr Speaker, Sir, I stand to support the Copyright (Amendment) Bill. However, I would like the Minister for Law to deliberate on several areas of the Bill. Clause 3 - Section 7(2A)(a) states what constitutes a reasonable portion for copying as not exceeding 10% of the total number of bytes. May I ask the Minister why this portion is fixed at not more than the 10% stipulated? Section 7(2A)(b) states "in a case where the work is divided into chapters, exceeds, in the aggregate, 10% of the total number of bytes in that edition but contains only the whole or part of a single chapter of the work". This is rather ambiguous, if not confusing. Does this mean that copying of 10% of each chapter is allowed or that the total copying of the whole edition regardless of the number of chapters should not be more than 10% of the whole text? Clause 10 - Section 51(5) specifies that a person cannot make a copy of any other part of that work "within 14 days after the day on which the previous copy was made." I would like the Minister's deliberation on this time interval. In my opinion, a shorter period like seven days would, in fact, be better as it facilitates the users' need for research. Clauses 15 and 17 - In section 120(1), the words "predominantly used" have not been defined. Similarly, the words were used again in section 136(a) and not defined. Clause 23 - Section 201B is unsatisfactory because it would cause some injustice. When the partnership or the body corporate has been charged or punished, the individual should be spared. Punishment to both individual and the partnership or body corporate would result in duplicity of charges and punishment. If the individual should be culpable, then he should be held responsible and not the partnership or body corporate.”
“Sir, may I ask the Prime Minister to define to this House the status vested on the wife of the elected President? What is the status of the First Lady?”
“Clause 44(1)(i) to (v) of the new Act provides for different types of disciplinary actions from fine alone to temporary deregistration before removal of name from the register. Sir, to conclude, I would like to say that with this Dentists Bill, we could have avoided the awkward situation, where the judgement of the Dental Board last year, in the case of a dentist who was implicated in breach of the Advertising Guidelines, was reversed by the High Court. While I agree with the judgement of the High Court in this case, I am concerned about conflicting judgements that may arise in the future. Would that case set a precedent for future cases of disciplinary actions by the Dental Council to be freely brought to the Courts of Appeal? Would that lead to undermining of the authority and judgement of the Dental Council? If so, is there a question mark over the legitimacy of the Dental Council and since the Dental Council follows the guidelines of the Dentists Act, would this Act be redundant? Sir, I support the Bill.”
“An unbalanced representation may cause the Committee of Complaints to be perceived as a "peer review or internal audit panel". Clause 36(7) and (10). These subclauses state that the dentist concerned shall not have the right to be heard by the Complaints Committee and shall not have access to all information used by the Complaints Committee. Sir, this is a denial of natural justice since it is only fair and logical for the dentist to be allowed an opportunity to defend himself. This is especially when the findings on each case of the Complaints Committee has such important repercussions as stated in clause 38. Furthermore, I am concerned whether the findings and recommendations of the Complaints Committee are admissible as evidence in any legal proceedings. Clause 39(2) and (3). There is no obligation on the part of the Committee to give its grounds of decision. How then is it possible for the aggrieved dentist to appeal with any substance? Clause 44(1). The appointment of a Disciplinary Committee as in this Dental Act has been long overdue and is urgently required to deal with the area of misconduct and the appropriate disciplinary actions to be meted out. Clause 44(1) has rightly categorised offences into either professional misconduct or improper act or conduct and five different ways to deal with an offence. This is superior to that in the old Act where a dentist could be deregistered for heinous offence or guilty of infamous or disgraceful conduct in a professional sense. There was only one penalty in the old Act, regardless of the severity of the misconduct - the wrongdoer had to be struck off the register of dentists.”
“Sir, this can become one control too many for the dentists and be an extra "bitter pill to swallow" for all the dentists, especially if the "such form and manner" becomes too restrictive and expensive to comply with. I would like to urge the Council to practise restraint and not to use the issuing of the Practising Certificate as a tool to pressurise and to cause extra demands on the dental profession. Clause 15(5)(b). In this clause, the words "is not of good reputation and character" are undesirably vague and wide. This criterion, Sir, is also very subjective. Perhaps, it should be qualified by adding the words "such as to render the person unfit, in the interest of the public, to practise his or her profession." Clause 17(6) and (7). There are no guidelines as to what premises or conditions are deemed unsuitable for practising dentistry. There is also no avenue of appeal. This makes it draconian and unsatisfactory. Clause 21(1)(e). This appears to be targeted at "bond breakers". There is inevitably a penalty imposed where there is a breach of undertaking. It seems inequitable and unduly harsh to deregister a dentist merely on this ground. Clause 34(1). This clause requires the Dental Council to appoint not less than five and not more than 10 lay persons together with not less than 10 and not more than 20 registered dentists as part of its Complaints Panel. This means a ratio of two registered dentists to one lay person is possible in the Committee of Complaints. Some people may argue that this will result in a bias in the assessment of a patient's complaint since there is an easy majority of dentists. The public would probably prefer a more balanced representation in the committee for assessments to be open and fair.”
“Mr Speaker, Sir, I rise to speak in support of the Dentists Bill. As it repeals and re-enacts, with amendments, the Dentists Act of 1985 that has become outdated and inadequate in many areas, its introduction is necessary and timely. Although there are several details that merit concern and comment, I feel that the setting up of a Dental Council to replace the Dental Board is significant and very welcome. Unlike previously, the registered dentists will now have their own representatives as spelt out in the amendments in clause 3, in this important "watchdog body" of the profession. Furthermore, the role of the Dental Board is not replaced by a 6-function regulatory role of the Dental Council, as defined in clause 4. All this should place the "watchdog body" of the dental profession in good stead in the eyes of both the dental practitioners as well as the general public. Sir, I would like to comment on other aspects of the Dentists Bill as follows: Clause 4. This clause defines the functions of the Dental Council and the function to determine and regulate the conduct and ethics of registered dentists is welcome indeed. This will provide the avenue for patients to bring complaints against their dentists. Furthermore, this will establish a means to protect patients from unscrupulous or unethical dentists as well as to ensure the high standards of the dental profession here. Many are concerned about the Dental Council having full control over the dentists in Singapore because the application for a Practising Certificate shall be made in such form and manner as the Dental Council may require.”
“May I ask the Minister whether the Ministry would be more lenient with our students who have borderline results to enter our tertiary institutions? RAdm Teo Chee Hean: Mr Speaker, Sir, wherever we draw the line, there will always be borderline cases. INTERVIEW DOCTRINE OF POLICE OFFICERS 7. Mr J. B. Jeyaretnam asked the Minister for Home Affairs whether his Ministry will make public the doctrine for questioning of police suspects laid down for the guidance of police officers. Mr Wong Kan Seng: Sir, the Interview Doctrine will not be made public. The Interview Doctrine is an internal confidential document to guide officers in their work within the framework of the law. It contains operational details for smooth running of police work in relation to the interviewing of persons. In particular, we cannot be `educating' the criminally-inclined to beat the system. Let me assure the House that the interviewing process set out in the Interview Doctrine is in accordance with the laws. This must be the case as the evidence admitted in Court by the Police must be able to stand up to scrutiny by lawyers and the Court itself.”
“Mr Deputy Speaker, Sir, I beseech this House to wholeheartedly aim for the "Singapore - Our Best Home" dream. The many recommendations made by the Singapore 21 Committee are but a foretaste of this dream. Nevertheless, it is a dream we can realise. Yes, we can realise this dream with a people who are focused on a vision and are willing to work and chase it with a united and wholehearted effort.”
“We must, therefore, set up the machinery for committees with dedicated members, who have clear visions of our needs, to follow and implement the above recommendations through one of our Ministries. On "leading healthy lifestyles", island-wide dissemination of information on healthy living and preventive care is required. Provision in this area is very much lacking now and should be given much more emphasis if we were to attain our goals. In the past, there was more emphasis on providing care for the results of ailments. The more correct path is on preventing the onset of ailments in the first place. We must, therefore, put constructive ideas to work and reap the resultant benefits. On "saving for old age", apart from re-enforcing the mindset of self-reliance upon retirement, providing for and encouraging participation in different types of insurance and annuity packages for old age savings should be enhanced. To encourage more people to save for this purpose, the Government should seriously consider tax exemption on interest earned on annuity. On "no one is too old to learn" and the "the elderly are not a burden but a resource", a lot will depend on how we can change the mindset of the people, and on the creation of opportunities and making these opportunities available to the elderly. Many of our elderly want to continue contributing to the society and are willing to learn. They, however, cannot find the avenues to do so. I suggest that we identify the vocations that are suitable for them, create, or even leave niche areas for them to fit in. We may then also have to create the channels to train them. If I may say so, there is no reason to exclude them as part of the future knowledge-based economy of Singapore.”
“Mr Deputy Speaker, Sir, I stand to applaud the excellent work done by the Chairman, the members of the Singapore 21 Committee and all those who have contributed to the very comprehensive report on how we may strengthen the "heartware" of Singapore in the 21st century. The five areas of study revealed many important observations and I am glad that the Committee has put forward many apt and appropriate responses to them. Sir, if we can act constructively on the various recommendations offered by the Committee, Singapore would definitely be an even better home for its people in the next century. I am particularly drawn to the section on "Strong families: our foundation and our future" and I cannot agree more with the "Subject Committee Recommendations" which say, "With an ageing population, there will be fewer working adults to cater for the aged parents. To ensure that this does not strain the family too much in the future, some messages must be taught and absorbed now: 1. Lead a healthy lifestyle to prevent illness in old age. 2. Save for old age. Plan our finances now. 3. No one is too old to learn. Focus not on what we cannot do, but on what we can. 4. The elderly are not a burden, but a resource. Whatever our age, we can still contribute." Mr Deputy Speaker, Sir, I would like us to go on to the next steps and translate the recommendations into reality. I would suggest some further ways to translate the recommendations into practice in this area. I felt that for us to realise our set targets and ideals, careful planning, good management and critical follow-up must be put in place.”
“In such circumstances, would the Minister consider installing the chillers for them and allowing them to pay by instalments?”
“Sir, may I ask the Minister if ENV would assist those meat sellers in our wet markets who have financial difficulties to retrofit and install the chillers in their stalls?”
“For instance, in the case of a medical practitioner, besides the $600 fee for the clinic licence every two years, there are fees for the practising certificate, medical insurance, equipment like an ultrasound machine, and so on. All these add up to higher costs and run counter to our aspirations of containment of healthcare cost. Would the Minister consider waiving the fees or at least keeping them reasonably low? (2) The new section 11 gives the Director or an authorised officer very wide powers to enter, search and inspect any premises and to ask a licensee to furnish information. Although we can understand that such powers are necessary to facilitate checking and compliance, I hope the licensees are not subject to excessive demands for inspections, data collection and submission or for surveys and audits. These can be counter productive insofar as they are fundamentally laborious, disruptive and expensive. I hope this Amendment Bill will enable the Ministry to fulfil an effective "watchdog" role. Sir, I support the Bill.”
“No doubt, the problem then was due to the "tender scheme" for HDB shops. In the amendment of section 2 under clause 2(b), the definition of "healthcare establishment" as any premises or conveyance (not being a private hospital, medical clinic or clinical laboratory or part thereof, and not being an establishment or conveyance maintained by the Government or the National University of Singapore) that aims to provide the services stated would mean that a wide range of premises or conveyance will fall within the ambit of the Act. Sir, would the Senior Minister of State for Health confirm whether a wider definition like this is intended so that traditional Chinese medical clinics, acupuncture centres, health spas, and the like, can be included for licensing? That these establishments may provide or attempt to provide diagnosis, treatment, or care of persons suffering from any disease, injury, or disability is indisputable. I applaud the provision for Quality Assurance Committees in new section 10 to enhance and ensure the quality standards at private hospitals and healthcare establishments. This amendment provides for transparency in quality control and reassurance to recipients of healthcare in Singapore. New subsection 10(3) is good, as this will give protection to quality assurance committee members and will facilitate their unrestrained and efficient contributions. My concern is on new subsection 10(4) in that the minutes of the meetings can be made available for any proceedings. Will these not erode the protection to the said members in any proceeding? Related to the implementation of the Act, I would like to urge the Senior Minister of State for Health to cause her Ministry to be mindful of two issues: (1) A surfeit of fees chargeable for various licences.”
“Mr Speaker, Sir, I rise to speak in support of the Private Hospitals and Medical Clinics (Amendment) Bill. I would like to declare that I am a medical practitioner. Sir, I must say that the introduction of this Amendment Bill is necessary and indeed timely. The extensive amendments are welcome as they suitably update the 1995 Edition of the Act to cater for the vast changes in the healthcare industry. It would appear to me that the main crux of this Amendment Bill seeks to rope in control of the so-called "healthcare establishments". I would suggest that the words "healthcare establishments" be inserted into the preamble of the original Act. Sir, this notwithstanding, I would like to seek clarification on several other matters in this Bill. Would the Senior Minister of State for Health clarify on one of the main objectives of licensing the various private healthcare establishments, laboratories, clinics and hospitals in Singapore as provided in this Bill? Is the assurance for quality of such premises or the control of quantity of such premises the priority? Sir, my concern is that with the latter, we shall create, in the future, a tradable commodity for those licences of existing practices. This will pose difficulties for young doctors to set up new medical practices and other healthcare personnel and concerns to set up laboratories and hospitals. The problem may be further compounded if the controlled and restricted numbers of licences from existing holders invariably become scarce commodities. Mr Speaker, Sir, I would like to know if the licensing mechanism will enable better distribution of healthcare establishments in Singapore. Let us be reminded of a past incident where six clinics were opened in the same block of an estate.”
“Sir, may I ask the Minister if we need to diversify our sources of food import as much as possible from now on and whether he will promote chilled fresh meat as the preferred choice of meat in Singapore, and if anything can be done and has been done to facilitate this?”
“Sir, as we strive for excellence in our education system, let us not forget that investing in basics and down-to-earth items, besides information technology may also help us attain our goal. I would urge the Ministry of Education to look into this. 3.30 pm”
“Sir, with the rapid rate of change, Singapore has become a nation of superlatives in many areas. The aspirations and expectations of Singaporeans have also become different and in keeping with the changing times. Life here has certainly been good and we understand what "comfortable" means. In the light of this, schools in Singapore also need changes to meet the new trends and to provide enhanced and conducive environment for our students. I would like to beseech the Ministry of Education to provide air-conditioning in all our schools. We now consider air-conditioning a necessity, not a luxury, in this tropical climate. Both students, as well as the teachers, can concentrate better and perform better in cool classrooms. In time, more students will spend longer hours in the school. Air-conditioning will certainly help the students get through the hottest part of each day. Cost will always be of primary concern. However, if it is value-added and allows for better performance in our young, air-conditioning school classrooms would have been worthwhile. It would have been a good investment indeed. Someone has even calculated that it would cost just about one dollar per month per child in order to have air-conditioned classrooms. This is not much and some schools have already started air-conditioning classrooms for privileged groups of students. This causes envy and jealousy in those deprived groups. This is not ideal as uniformity and fairness to all should be our policy. Many schools have air-conditioned computer rooms and libraries. The reasons given for air conditioning them would apply to the classrooms equally well.”
“This trend is going to stay, and parents would be delighted to know that as they work, their children are safe and are supervised in their work after school. This latchkey system can also prevent children from mixing with the wrong crowds after school. It is a fact now that many students get private tuition that can cost hundreds of dollars per month and tax heavily upon the resources of the family. Perhaps the extra help or even group tuition given after school will lessen the financial burdens in many families. Although more Before-and-After-School-Care Centres are being set up in HDB void decks and community centres, I feel that schools would really be ideal for this type of care. The convenience and lower cost will be plus points for such care at schools. The Minister for Education can allow schools to employ part-time staff, encourage volunteer parents and tap resources from grassroots and voluntary groups to mind the after school care programmes. Space constraints have been given as the reason by many against the idea. The truth is that a converted classroom or a simple portable cabin or container is all that is needed. Sir, I hope the Ministry of Education could look in further and improve in these two areas.”
“Sir, I would like to raise concern over the anguish felt by many students and parents in lieu of the early operating hours in our schools. It was reported in the Straits Times that Tan Ming Ming (not her real name), an eight-year-old in Primary 2 gets up every morning at 5.00 am to catch a school bus at 5.45 am. This is so that she can be in school by 7.20 am. This is a familiar story and a cause of much anguish expressed by many parents. I think we need to review this correctable situation. I am suggesting that whenever possible, as in the case of single-session schools, the schools should start later, at say 8.20 am earliest. This will enable school buses to stagger pick-up times and ease the traffic flow in the mornings somewhat. Furthermore, the peak rush hour for the office workers, who usually start work at 9.00 am would not be adversely compromised. There are many single-session primary and secondary schools that still stick to the 7.20 am start times when, in fact, there is no more need for it to be so. A change will avoid the frustrations in the early and dark hours of the morning for many students going to school. This will reduce the pressure on parents who have to get up to prepare the breakfast for the children who, in turn, complain that they have no appetite at such a time in the morning. This will mean that students have to eat lunches in schools and stay longer in schools. This, in fact, is a good thing, which brings me to my second point, relating to the "after school care". Sir, there is a place for all schools to provide "after school care" to those who require this facility. This would be especially easy with the single session schools. We should cater for a changing trend where many families become dual-income earners.”
“The other reason is that the present generation of elderly is also a "hardy breed" and some do not see such behaviour as abuse. Sir, "elderly abuse" can be physical, with injuries; psychological, with anguish and emotional trauma or material, with neglect of the elderly who are left with no comforts, funds or resources. Tell-tale signs of abuse would be poor hygiene, malnutrition, dehydration, unexpected injuries, depression, physical as well as social isolation. Sir, we must not treat "elderly abuse" as a non-existent issue. We need a national effort in tackling this problem. The law, Part VII of the Women's Charter, has been amended in 1997 to address the relevant provisions for the protection of abused parents. The Ministry of Community Development could spearhead the next move by: (1) making concrete plans and creating a body to promote public awareness of "elderly abuse"; and (2) coordinating the activities of various organisations, including hospitals, voluntary organisations, social and legal service providers, as well as programme and research resource centres to facilitate assistance to the abused elderly. Sir, it is of paramount importance that a civilised country like ours does not turn a blind eye to this social ill.”
“Sir, for six years, Mr Lee Tan Lim (not his real name), aged 96, faced a wall of silence from his son, his daughter-in-law and their three children. For six years, his wife was slapped on the wrists each time she failed to follow her daughter-in-law's orders. They fended for themselves with money saved from "hong bao" given by their daughters and friends. They bought their own food and paid for their medical expenses with money they have saved. Their son and his family abused this elderly couple in both emotional and physical terms. The immediate response from most people would probably be that the aforesaid is a rare and unusual situation. Is it really that rare and unusual though? Statistics from Subordinate Courts show that one out of every 34 police protection order (PPO) applications filed here between 1st May 1997 and 30th June 1998 is from a parent. It works out to be 86 cases. According to Tsao Foundation's Hua Mei Mobile Clinic, a non-profit organisation devoted to the care and well-being of the elderly, they see about 10% of "elderly abuse" patients in their practice. Research has found that almost one out of 26 people aged 60 and above in the United States is an abused person. Studies in Japan show that those most vulnerable to abuse are in the over-75 age group, and the most common type of abuse is neglect. It has been said that "elderly abuse" is a silent tragedy in Singapore because most people shy away from making their problems known. In Singapore, "elderly abuse" is definitely under-reported. It is Asian culture to cover up family problems, to avoid being stigmatised and to spare themselves or their families from public embarrassment.”
“Watch their daily food intake, ensure them daily exercises, and give them enough mental stimulation. All these, together with early detection and treatment of diseases, will dictate the numbers of the sick dependent elderly in the future. (4) Provide financial, personnel and logistical support to achieve our aim. The MCD should support grassroots organisations, non-profit organisations and other self-help groups run CARE. A lot of people may have the interest but they need the know-how and the financial help. Providing care for the elderly can be rather expensive because the elderly frequently do not have enough funds when they retire. The elderly, as a socio-economic group, also do not get much in terms of priority for their well-being and general care. (5) Provide elderly-friendly features in their habitat to enable them to stay for as long as possible in their own homes. Here, the MCD can help by providing the information, the advice, and the expertise to those who need the help. 5.45 pm Sir, it is important that we succeed in this area of eldercare. It will be a big task because we are expecting to have about one million sixty-plus citizens by the year 2030. The MCD would have succeeded in this area if the quality of life amongst the elderly has been improved and the number of dependent elderly has been reduced. The rewards for society from the multiple effects of good health, quality lifestyle, and less expensive healthcare will be enormously significant. Sir, I urge the MCD to prioritise this area and make good eldercare a success. Sir, could I move on to my last cut?”
“Sir, I believe that MCD should go this way in order to stay even more relevant and cope with the changing social trends and changing demographic profile in the future. I would like now to go on to my next cut. Sir, there is an increase in the life expectancy of our people now to about 80 years in age. The majority of elderly will now have about 20 years more to live after retirement. This is very much the resultant effect of modern science and technology. Sir, to most of the elderly folk, the quality of life rather than longevity becomes the issue that matters to them. It will be good, therefore, to revamp our system so as to enable quality living for our elderly. The Ministry of Community Development could aim towards promotion of quality lifestyles so that as many elderly can stay happy and healthy in the community for as long as possible. I would like to propose that we set certain broad guidelines to achieve our objective: (1) Promote positive attitudes towards ageing through public education targeting a change of mindset in both the young and the old in our society. (2) Help the elderly to be engaged within the community for as long as possible. This can be achieved by (a) getting them involved in the neighbourhood CARE (Centres of Activity for Retired and Elderly); (b) encouraging a buddy-system type of caring for each other; (c) involving them in new hobbies, and (d) getting the various voluntary care groups coordinated in their efforts. Ideally, every constituency should have at least one of such centre. (3) Limit and delay the onset of disabilities in old age, which more often than not are due to diseases. It is important to have healthy lifestyles and preventive healthcare.”
“Caring for the elderly in Singapore needs a new approach if we are to cater for the fast-increasing numbers of a very expectant group of senior citizens. Sir, the emergence of this new group and a very different trend in requirements will dawn on us very fast indeed. Only through good foresight and fast planning will the Ministry of Community Development (MCD) stay relevant in the new era. Sir, the MCD should serve as a centralised body in Singapore to effect a coordinated plan towards care of the generally well elderly. Care of the elderly is no more a question of simply providing necessities like food and lodging. Care of the elderly is about quality of life provided through a holistic approach or total care concept of catering for the physical, social and mental aspects of life. The majority of our elderly, 95% of them in fact, are ambulant and in reasonably good health. Only 5% of them require institutional care either because they are disabled from illnesses, or because they are too frail. Our aim, therefore, is to try and keep the 95% of elderly who are "relatively well" remain happy and healthy. Programmes need to be revamped to achieve these targets. The success of these new trends of care will not only make our elderly happier and healthier, but they will also: (1) reduce the burden on many family members who would otherwise have to look after the elderly themselves; and (2) benefit the nation through reduction on use of high cost care in the healthcare institutions. The Ministry of Community Development should just focus on the ambulant and relatively well elderly and leave the dependent elderly to the Ministry of Health.”
“Sir, it is reasonable and appropriate that they provide medical coverage to healthcare workers more susceptible to contacting diseases while working.”
“Another medical officer was admitted in November 1997 for gastro-enteritis which he had apparently contracted during his night duty. He had to pay $1,233.67 for four days of stay. Again, no professional courtesy was exercised by the hospital he was working in. The aforesaid were two cases of many more similar situations faced by junior doctors. Employers are morally law bound to medically cover occupational mishaps and disabilities arising from work. It is imperative that the healthcare sector should not be an exception. In many other industries, the employees receive services from within the industry they work in, often as part of the benefits. Doctors and healthcare workers should be given the same privilege. Sir, doctors are exposed to a vast array of health hazards, such as infectious diseases, in the course of their duties. Medical benefits for medical practioners in the civil service have been pegged to the level of other civil servants that are not similarly at risk. Many doctors feel that as they are more at risk, they should be better covered for these risks. Many doctors also felt that the mechanism for their medical benefits was not apparent to them. I am sure the Ministry of Health intends to have the welfare of junior doctors adequately looked after. Sir, this is one area requiring some adjustments by the Ministry. The perpetuation of the aforementioned incidents and the negative publicity it received is unhealthy. It is detrimental for the morale of junior doctors and deleterious to public opinion upon the hospital and the Ministry. The Ministry should set the pace and show itself as a responsible and caring employer.”
“Sir, Singapore has a growing reputation as a hub of medical excellence in the region. This did not come about through chance. This came about through the high professional standards maintained and provided by a pool of well-trained doctors and healthcare workers. We will need a continuous stream of junior doctors coming on in succession. To get top notch doctors, we need training for these juniors. Conversely, these juniors need the training to move on career wise. They are usually bonded. They are often over worked, and they are perhaps underpaid. Most of all, they have little or no choice but simply to get through with their stint in public service. This may cause loss of morale among the junior doctors. I feel strongly that for the junior doctors to give of their best, the Ministry of Health must first have their welfare at heart. Today, I would like to highlight the unhappiness of many junior doctors concerning their employment benefits, especially their basic medical benefits. Sir, a medical officer was admitted to hospital in March 1997, suspected of foreign body ingestion. He was found to have pulmonary tuberculosis. He stayed for a total of seven days in B2 Class and had to pay $1,496.08. It would have been $4,539.50 if he had chosen an unsubsidised ward. He had to pay the entire bill like any other patient, and only the surgeon's fees were waived, but not the anesthetist's fees. During this period, he was working as a medical officer in the same hospital. It is possible that he contracted tuberculosis from his patients. The point here is that he felt that some form of professional courtesy, like what the surgeon had, would have been extended to him for being a staff of the hospital.”
“I have also suggested that perhaps another insurance scheme, "Medicare" - a patient/Government co-payment scheme, may fill this inadequacy. I am delighted therefore that the Inter-Ministerial Committee on Healthcare for the Elderly has recommended an insurance scheme to solve this problem. However, I would like to ascertain if the scheme, though applicable for those with disability, would be applicable for those patients who are relatively well, and in fact, only need some help to pay for outpatient long term expenses on chronic diseases. This will constitute a very important proportion of long term healthcare. Sir, chronic illnesses will be a big financial burden to the afflicted and it would pose substantial recurring expenditure for them, for instance, to control diabetics and hypertension. Long term medication and regular follow up are necessary to prevent complications from these diseases. It has been noted that in times of economic crisis like this, patients have been self-reducing intake of medications and missing follow ups so as to save costs. This is a hazard from the lack of means and if this part of long term healthcare is not eligible for claim, you will defeat the tenet of your plans on healthcare for the elderly. I hope the Ministry of Health will clarify on this area. I am very glad indeed that all the various issues and their remedies on the elderly, which I have raised in this House previously, have been addressed in the Inter-Ministerial Committee Report. I am also very pleased that there is perfect conformity between my ideas and remedies with this report. I beseech the MOH and the MCD to hasten and to effectively implement all the recommendations.”
“The training of more general practitioners in geriatrics would be a welcome path to take. More training should also be offered to nurses and physiotherapists in geriatrics medicine. And even if it is scant, recognition and encouragement should be given to volunteers trained in home nursing. They can certainly lessen the load of home-caregivers and medical personnel; and c) the Ministry of Health should look into forming a permanent team specialising in the early detection of chronic illnesses and in the provision of better care of those chronic illnesses. Any morbidity and mortality from any disease can be dramatically reduced when the diseases are treated in their earlier stages. It is essential that the team be geared to reach the masses at the local community level. Sir, the Ministry of Health influences the health matters of the whole population. Making the right plans and taking the right measures can make all the difference in whether our people will be even healthier and happier. I would like now to go on to my next cut. I am very glad that some headway has been made in establishing the basic tenets of "long term healthcare" for this country. There is an urgent need for us to look into "long term healthcare" from this moment in time because neglect in this area could have devastating effects for us in the future. I think the report of the Inter-Ministerial Committee on Healthcare for the Elderly has given us a very comprehensive overview of what work is in store for us. I have raised in this House, more than once, the issue concerning the inadequacy of the present "medi-plans" for elderly Singaporeans at financing their "long term healthcare".”
“Thank you. I would like to declare that I am a medical practitioner. Preventive healthcare is all-important in ensuring a population of healthier people. It should be promoted vigorously and it should be targetted at everyone. Today, I would like to emphasise preventive healthcare for the elderly. Sir, this needs urgent attention because we face a fast-aging population in Singapore. It is crucial that the Ministry of Health facilitates the various efforts at helping the elderly to stay as healthy as possible and for as long as possible within the community. This is the way to reduce the nation's otherwise colossal burden in financing the healthcare for its people. Sir, I would like the Ministry of Health to strengthen the following areas: a) support should be given more readily to community centres, voluntary group organisations, and grassroots organisations caring for the elderly in the community. The support need not be financial all the time. Logistics advice, deployment of available personnel, loan of resources or even simple endorsements of support may be all that is needed. Giving advice on setting up of Centres of Activity for Retired and Elderly (CARE), providing paramedics for health screening checks and conducting of educational talks at the community level are some examples of such help. The Ministry of Health, acting as a centre and facilitator to coordinate volunteer doctors, medical students and nurses, will be able to reach out to more people in more constituencies; b) the expansion of home-care facilities could be looked into more comprehensively within the Singapore context. This can be achieved by training more personnel that are relevant and interested home-caregivers who look after the sick and elderly at home.”
“Sir, may I have your permission to take my two cuts together?”
“May I also ask for redoubled efforts in combating the drug abuse from all angles, including increased public education, concerning the risks of drug use, targeted at children and parents?”
“Sir, an English woman, Miss Leigton, took two half tablets of Ecstasy, in a London night club, over an interval of three hours and when she woke up later that day, she collapsed because she had suffered brain damage due to a lack of oxygen to the brain. How many of our Singaporean youths know about the hazards of Ecstasy? Ecstasy is an illegal synthetic so-called designer drug. A designer drug mimics an already illegal drug by slightly altering the chemical composition. Ecstasy is also called MDMA (methylene-dioxy-meth-amphetamine). The amount of MDMA needed to get "high" is close to the toxic dose. Ecstasy acts as a stimulant to the central nervous system. Immediate effects include feelings of detachment, feelings of euphoria and increase in heart rate. Immediate side-effects are nausea, fainting and even death. Long-term effects are high blood pressure, psychotic episodes, kidney failure, stroke and death. There are now "killer drugs" which may have 33 times the potency of Ecstasy flooding night clubs in Britain. Those buying them have no idea of their strength and often find out too late. We in Singapore have to be extra vigilant in preventing their entry into our market. New variations in the pharmacological make-up of these drugs may allow drug pushers to escape detection and punishment. One of these drugs, so-called "Flatliners", has killed several people, while another, known as "DOB", makes Ecstasy seem like aspirin. Dealers and manufacturers are pushing any substance that they are able to sell in a buyer's market. The market has been greedy both for new drugs and for the vast sums of money that can be made from these drugs. I would like to urge the Ministry of Home Affairs to be vigilant and to be mindful of the variants of Ecstasy in the local scene.”
“Sir, whilst we do not want to over regulate and affect Singapore's pro-business environment, the Ministry of Trade and Industry must not neglect this responsibility for anything.”
“Sir, I would like to raise my concerns over the safety of consumer products in our local market. Most of us assume the constant presence of watchdog bodies that ensure products sold in Singapore would be free of toxic or harmful effects. I would like to suggest that our assumptions should be upheld and a regulatory body, either under an inter-Ministry body or MTI control, should be there to monitor all products and ascertain that they do not contain hazardous substances. This must be put in place to protect the consumers' interest. Sir, this is especially important when, in fact, the consumers are our children. Indeed, products that contain harmful substances, harmful to children, have been found in the market. In Hong Kong last year, according to the environmental group "Greenpeace", cancer-causing toxins have been found in soft polyvinyl chloride (PVC) children's toys. The warning about this came after the group commissioned independent tests and found phthalates in 28 toys bought from seven stores in Hong Kong. Toys were not allowed to have more than 3% of phthalates. These toys included a teether, a plastic key, some dolls, and some bath toys. Young children chewing or sucking on the products could ingest the chemicals that were used to make plastic soft and flexible. Links have been established between phthalates and liver as well as kidney cancer. The chemicals can also damage reproductive organs. I must beseech the Ministry of Trade and Industry to take necessary preventive measures to ensure that any consumer product, whether imported or locally produced, does not pose hazards to public health.”
“Mr Speaker, Sir, there is a tremendous challenge facing us in the scope of healthcare in Singapore. The earlier we embark on meeting this challenge, the lesser we will feel the pinch of the expense and the better we can cope with the needs of our people. Sir, the provision of more money, and in steadily increasing amounts each year, is emerging as the way to successfully deal with the future healthcare needs of Singapore. Sir, the Minister for Finance holds the key to the money.”
“A good illustration of this would be in the management of cancers. Many cancers, examples of which would be cervical cancer and breast cancer, are curable if detected early. Pap smear screening tests which are available readily in Singapore for many years have reduced the incidence of cervical cancer. We have now got to address the situation with other conditions. The prevalence of breast cancer - the most common cancer among Singapore women - is a good one to start with. We must see that funds are allocated towards more public awareness promotion programmes and mass mammography screening programmes. Accelerated provision of personnel and mammography machines are necessary to reduce the incidence of breast cancer. The Government must increase the aid given to voluntary groups that work for and support those with breast cancer in Singapore. (5) Singapore has a growing reputation as a premier regional medical centre. High professional standards and a pool of well-trained doctors and healthcare workers have to be maintained to provide quality medical services. There had been a stream of foreign patients being treated in Singapore prior to this economic crisis. Although the numbers of such patients may have decreased, we should continue to maintain our reputation as a premier regional medical centre. To do this, more funding must be provided for more training and research, especially in those areas fast improving in science and technology. It is better for Singapore to keep abreast of new knowledge, perhaps even generate new knowledge, in order to remain relevant in this medical arena. This cannot be achieved without adequate and timely funding. Maintaining men and machines means money.”
“The capital sharing of 90% by Government, which is still too onerous, may have to be reviewed as well. (2) Sir, increased funds for setting up more disease prevention and intervention programmes will reap us rewards in the future. The key to successfully reduce projected cost of future healthcare burdens is to promote healthy lifestyles and provide preventive healthcare. The rewards can be immense if this is done swiftly and targeted towards the whole population. It has been shown that, among the middle-aged in Finland, the number of deaths from heart attack and cerebral stroke could be decreased to less than half through preventive measures. (3) Another area that needs more funding, Mr Speaker, Sir, would be in the training of more healthcare professionals and other informal caregivers for the elderly. Training in geriatrics for doctors has to be accelerated and the opportunity for such training must be extended to all doctors and nurses. All these efforts will not only provide better care for our elderly but also facilitate the availability in due course of home care. The gist of "elder care" is to keep our elderly as ambulatory for as long as possible, to keep them in the community for as long as possible, to tap the care of families, friends and voluntary groups in the community for as long as possible. Institutional care should be used only as a last resort. In order to achieve this, promotion of healthy lifestyles and preventive medicine to our elderly is essential. More trained personnel is needed to work at the grassroots level island wide for this to succeed. Sir, this will require a lot of time, effort and funding. (4) Support is also needed to address issues of prevention, early detection, treatment of many diverse conditions.”
“In order to cope with the changing social trend, there is an urgency to revamp some areas in our current healthcare system. Mr Speaker, Sir, our current healthcare system is very much orientated for a "young population". Our demographic profile is undergoing rapid changes, and our population will become a mature one within the next generation. By the year 2030, the elderly would constitute a tremendously increased 20% of the total population. There will be an increased prevalence of chronic diseases with conditions like dementia doubling in incidence. Sir, the elderly, those aged 65 years and above, consume a disproportionate amount of our healthcare resources. This increasing trend of demand will strain our present healthcare system. We have to be proactive to meet the needs of a `mature population'. Mr Speaker, Sir, I would like to suggest that more funds be allocated to the following areas at the very least: (1) More funding, and an urgent one too, is required for building more nursing homes. We are short of 1,600 nursing home beds and we shall need about 15,000 more beds by the year 2030. Facilities for long-term care either in the institutional, day care or home care settings will have to be strengthened to cater to the needs of a "more mature" society. Sir, since voluntary groups run the majority of our nursing homes, and we need a speedy boost in the number of nursing homes, the Government may have to review the present method of funding. There is a need to encourage more voluntary groups to build more and reduce our shortfall. The present 50:50 sharing of running costs may be a little too arduous for many voluntary groups. The cost of building a new nursing home runs into tens of millions of dollars.”
“I thank you, Mr Speaker, Sir, for allowing me to participate in this debate. My intention is to appeal for bigger and sustained budget allocations for the Ministry of Health yearly. I would like to beseech the Minister for Finance to give my request earnest consideration in view of the fast and vast improvements in science and technology within the medical field and in view of the social changes within our society. Sir, the Ministry of Health, as a non-profitable and "expense only" economic contributor, may have received a low priority not only this time round but also in the future. However, I feel that this should not be the case because we may compromise our excellent healthcare system. The Ministry of Health deals with life - the very essence of our being. We would have accomplished nothing if we lag behind in providing excellent healthcare and in maintaining our people at their best in health. For the past few years, Singapore's national health expenditure has remained stable at about 3% of GDP. However, a recent NUS/IPS study commissioned by the Ministry of Health indicates that Singapore's national health expenditure, at the current level of health servicing, will rise to 7% of GDP by 2030, due to the `ageing factor' alone. Sir, the economic pressure is also likely to be aggravated by rapid advancement in medical health science which brings, in its wake, the introduction of many life-saving but expensive new medical technologies and innovations. The present generation of Singaporeans is more savvy and will be even more so in the years to come. They will have higher expectations of our healthcare system and will demand much more in terms of their healthcare needs.”
“Only then, Sir, can all those involved in the management of the disease feel at ease to handle the condition in a normal way. Only then, perhaps, can the infectious disease be effectively managed and contained. (2) Each country deals with this disease in its own way and the solutions for one country may not be relevant to another or to us here. Sir, though fortunately not an endemic problem, the incidence of HIV infection or AIDS is increasing in Singapore. We should take every measure possible to keep it in check. Our population and our problems are unique to us and there is scope for us to take more stringent and radical steps to combat the increase of the disease. (3) There is a need to inform and advise all doctors and healthcare workers on new regulations pertaining to their profession in simple terms. Many of them would not know about the amendments to this Bill and the details contained therein. Perhaps the Ministry of Health would keep all relevant parties well informed. I hope the Senior Minister of State would enlighten me in these areas. Sir, I support the Infectious Diseases (Amendment) Bill.”
“Sir, I feel this amendment may help lessen the number of females and children from potential infection. The argument against this new subsection may be that people who suspect they themselves may have HIV infection would be reluctant to come forward for fear of being disclosed. This, however, has been addressed through certain safeguards. One of them is the requirement for the medical practitioner to counsel and inform the infected person of his intent to make such disclosure to the spouse, former spouse, or other contacts. Otherwise the medical practitioner shall be guilty of an offence and shall be liable on conviction to a fine not exceeding $2,000 or to imprisonment for a term not exceeding three months or to both. Mr Speaker, Sir, I would like to ask if the Senior Minister of State would consider three further aspects on this Bill. (1) Not included for a further consideration with these amendments is the subject of consent for diagnostic investigations for HIV infection or AIDS. I feel that a responsible approach together with these amendments in place should provide sufficient protection from breach of confidentiality of a person with HIV infection or AIDS. Sir, on the other hand, it is important to protect those who are at risk of exposure and it is important to protect the public by keeping the infectious disease from spreading. The ease to diagnose, to identify and to treat the infected and their contacts would be the key to effectively deal with these aspects. HIV infection or AIDS should be treated like any other infectious diseases. The consent for diagnostic tests should be implied when a person gives general consent for medical or surgical treatment. There should not be a need for specific consent.”
“For example, the warning about the penalty may need to be prominently marked on the blood transfusion registration forms; the warning may have to be posted in the wards of the Communicable Disease Hospital and the same warning may need to be clearly explained to newly diagnosed HIV patients. Sir, my question to the Senior Minister of State is, in those recalcitrant cases that do not heed any warning and are callous in their behaviour within society, what further preventive measures can be meted out? Could these offenders be made discretely identifiable to the relevant authorities or persons? Could these offenders be forcibly put behind bars? Since confidentiality will be an issue here, who with the privileged information can report them? Amendment of section 20D The amendments here include the addition of four more exceptions to medical confidentiality for HIV infected patients in subsection 1 and the insertion of new subsection (12) to provide for medical confidentiality and disclosure of the identity of infected patients. Mr Speaker, Sir, such a large list of new provisos indicates the tremendous difficulties involved in this very sensitive issue. The newly inserted subsection (6) allows medical practitioners to disclose information identifying the infected person to his spouse, former spouse or other persons who have experienced a significant risk by being in contact with him. This is welcome news especially when these contacts of the inflicted may generally be the highest at risk of being infected. Among 90% of the known cases in Singapore are males. In 1998, there were 830 males with HIV infection and in the past two years, eight children were detected to have HIV infection.”
“It is timely because any means of deterring a repeat of that tragic incident in 1997, as mentioned earlier by the Senior Minister of State, when two blood recipients contracted HIV infection because a blood donor had lied about his promiscuous habits, is most welcome. Sir, some people may argue that such strict deterrents will result in fewer much needed blood donors. However, much as we need blood donors, the safety of blood recipients must be protected as a matter of highest priority. The majority of blood donors volunteer as good Samaritans. They want to be contributing a good service to the society. They want to be saving someone's life. With such good intentions at heart, the severe penalty imposed on errant donors will not interfere with their willingness to continue as blood donors. It is necessary, however, for the public to be assured that the intent is not to penalise blood donors liberally but to dissuade those with high risks to abstain from blood donation. I hope the Ministry of Health can step up in its campaign in this area. Amendment to section 20C Sir, this section provides an enhanced penalty of up to $50,000 in fine where a person who knows that he has HIV infection or AIDS donates blood or does any act that is likely to result in the spreading or transmission of those diseases. Although it is good to have this clause, the resultant effects would depend on the next task for the Ministry of Health. This task would be to ensure that the targeted group gets the message.”
“Mr Speaker, Sir, I would like to declare that I am a medical practitioner. I stand to support the Infectious Diseases (Amendment) Bill. In my opinion, the amendments in this Bill will give better protection of the public with regard to Human Immunodeficiency Virus (or HIV) infection. We know that there is no cure at present for those suffering from Acquired Immunodeficiency Syndrome (or AIDS) because of HIV infection. Therefore, any improvement towards protecting innocent people, through no fault of their own, from getting the deadly HIV infection, is welcome news. Indeed, I believe that having stringent measures in place to deter inconsiderate or ignorant people from harming others through HIV infection is prudent and timely. I agree with my parliamentary colleague, Mr Bernard Chen, that the action by such people amounts to giving their victims the death sentence and such action, whether intentional or inadvertent, must be considered illegal, to say the least. Sir, I would like to contribute the following concerning the amendments: Insertion of new section 10A The insertion of this section 10A to create an offence when blood donors supply false or misleading information and to set a maximum penalty under this section as a fine of $20,000 or a term of imprisonment of two years or both is necessary and timely. It is necessary because there is this `window period' when presently available tests cannot detect an early HIV infection. Although with new technology, this `window period' will become shorter, it is extremely important that blood donors give truthful information, through detailed questionnaires. This is, unfortunately, still the only way to minimise the risks of innocent blood recipients from being infected.”
“To repeat what I suggested in this House, we need a co-payment insurance scheme to cater for long-term care outside hospital settings. I would call this "Medicare". "Medicare" will provide for burdensome and chronic but non-institutional care. In some instances, this may actually be the preferred alternative care - "home-care". This will reduce the load placed on hospitals and nursing homes. Presently, the facility to use Medisave only for hospital and nursing home admissions is an important consideration causing many patients to favour institutional-care instead of home-care. This, again, is a waste of expensive resources. Mr Deputy Speaker, Sir, let us give special attention to these seemingly remote issues, even as we cope with this economic crisis. It is far-sighted vision and far-reaching preparation, the hallmark of the PAP Government, which will prevent and cushion Singaporeans from catastrophes in the future.”