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, spending just one evening in a discotheque can leave a young person with a severe hearing impairment and very definite threat of deafness. Dr John Hazell, head of medical research at the Royal National Institute for the Deaf, said that nearly all his patients with problems caused by clubbing had done it for just one night. Up to 80% of night-club patrons would end up with some kind of hearing damage. In Germany, researchers found that up to 25% of young people had impaired hearing from listening to loud music and about 10% of the nation's 18-year-olds suffered such severe damage that it would handicap them in normal conversation. Sir, may I ask the Minister for the Environment if we have any specifications and permissible safety limits of sound level for the discotheques in Singapore? And more importantly, can we protect the public, especially the young, from this type of deafness through public education?”
“Sir, the immediate health hazards caused by haze, like eyes, nose and throat irritation, skin rashes, asthma and other respiratory problems are obvious. The long-term ill-effects, however, are not so easily determined. A study from Harvard University suggested that particulate pollution over a period of time was strongly associated with deaths from lung cancer and heart disease. Another study showed that particulate pollution reduced the average life expectancy by one to three years in some of the polluted cities. May I ask the Minister for the Environment if his Ministry would analyse all the available data and enlighten the public on the various possible long-term effects. And since we are in the thick of our own particular type of haze, would his Ministry be planning our own study, maybe in collaboration with the World Health Organisation, on the short-term as well as the long-term health hazards of the pollution problem in the region? Sir, these findings will benefit not only ourselves but also our neighbors. It will enable all of us in the region to be more resolute in curbing the problem and to be more prepared in dealing with the ill-effects of the haze.”
“These activities may include items like (a) having trained personnel going around perhaps on a monthly basis to the different community centres or day care centres to advise the elderly and the womenfolk , and (b) having another group covering the community at work at their working places. The Community Development Councils, the community centres and the corporate establishments should participate in the logistics and planning to reach out to the people. Incentives and other aids should be given to them. We should help the private companies realise that such programmes will enable them to have healthier workers leading to enhanced productivity as well as providing their staff with essential health screening tests conveniently and at affordable prices.”
“6% of the Ministry of Health budget is allocated to Primary Health Care and Preventive Health Care. There are only five people in the Public Health Department doing promotional work on preventive care for the elderly and womenfolk in the whole of Singapore. Another five are catering for the needs of the whole mass of the workforce. This is really inadequate for promoting healthy lifestyles to the whole country. Sir, I would like to suggest that we embark on a mass public education programme on preventive healthcare. There is a need to promote the idea of personal responsibility for one's own health and the ways of attaining and maintaining good health. Health screening tests, on a regular basis, should be made available, especially to the poor and the elderly who are most in need but the most deprived. We can conveniently reach a target group making use of the numerous day care centres for the elderly; we can organise mass programme at the community centres and we can increase awareness that such tests are available at the island-wide and well-scattered polyclinics. We already have a very good network of helpers, like the grassroots leaders and other caring residents who can help to reach out to the people. We will also need to provide training for facilitators in the community who have the direct and continuing contact with the primary target groups. These facilitators may be the nurses at the polyclinics, community leaders of their community centres or the personnel officers in the various large companies. We need a more consistent island-wide systematic approach to promote different aspects of healthy living and preventive care.”
“Following what Minister Yeo said earlier on the alternative minority institutional care scheme for the elderly and chronic sick, in fact, it was in my speech earlier that I was trying to give an answer to that group of people who did not have enough Medisave and therefore, having this scheme where there is a co-payment between the Government and the patient to help this group of people. I hope the Minister will really look into it and maybe he could understand better what I was trying to say. Now, on preventive healthcare service. "Prevention is beter than cure" is an adage all and sundry knows. Promoting preventive care as the way to go is accepted by the majority of healthcare providers. Failure of preventive care will call for more palliative treatment and laborious nursing of end stage progression of illnesses This is most unrewarding. Not only does it eat into people's well-being, but it also eats into people's pockets. Are we in Singapore doing enough in this respect? The answer is "No". Could it be that we are still very much caught up in the stage of coping with curing illnesses and the priority for preventive healthcare had to be compromised? Sir, we really have to redouble our efforts in promoting preventive healthcare if our nation is to maintain our high healthcare standards and to contain our low healthcare costs well into the next century. The Public Health Service does provide health screening and some preventive care for our school children. It has been rather successful in this area and this is commendable. However, it is a very different story in the area of the general workforce, the elderly and the womenfolk. It is this area that we are concerned about. At the moment, only 13.”
“Sir, the main point here is for us to have enhanced health insurance for our people at affordable rates and to spare the use of Medifund for the truly deprived. Making the public aware and more responsible for their own healthcare will be the key to successful implementation of healthcare planning for the future. While the three `Ms' (Medisave, MediShield and Medifund) can take care of almost all our needs, complacency and allowing things to remain status quo cannot guarantee us affordable healthcare in the longer term.”
“If these CPF members are also covered by MediShield, they can claim a maximum of $20,000 per policy year and $80,000 per lifetime. This means we can have one category of people having, at best, access to $100,000. We have also to consider two other categories, those who cannot accumulate enough Medisave and those who are already retired, both of which not having that much access. Now, if people are going to be living maybe 20 years beyond their retirement age, the very finite amount of $100,000 from their combined Medisave and MediShield, for future use, may not be enough even at current rates. As healthcare cost, in dollar terms, will definitely increase, there will be heavy dependence on the children's funds or the Medifund. It is not good to leave such a legacy for our children and country. Is having more Medisave the solution? I do not think so. For a start, the majority of people would be reluctant to put more money aside through compulsory savings. Should we raise the MediShield coverage? This is a possibility. But, it is likely that this expenditure may just overburden the subscribers. It is unlikely that any simple increases in payment will go down well with the people. Sir, I propose that we consider MEDICARE as a further counter before turning to Medifund for help. The difference between MediShield and MEDICARE is that the latter will be insurance derived from a co-payment scheme with the Government and it will be cost-index linked. Perhaps such co-payments may be made by the children on behalf of parents who are near or past retirement age. These features should make this health insurance more acceptable to the people and they could be persuaded to take up this extra expenditure.”
“A crucial dilemma which many of our people, especially in their old age, may face in the future will be the effects of having insufficient funds to meet the cost of health care. This can happen in spite of the Medisave and the MediShield schemes which we have in place even as of now. This is due to the fact that people are going to be living longer and healthcare costs are undoubtedly going to be higher. Furthermore, we do not have in place the kind of financial support needed by the increasing numbers of chronic sick in those institutions where, at the moment, Medisave and MediShield cannot be used. Sir, this problem has to be looked into now and we must come up with the solutions in good time. The Medifund, set up by the Government not too long ago, is one step in the right direction. However, further steps must be taken or we will need huge increases in Medifund and other subsidies, at the expense of the next generation, to cater for the progressive demands of good healthcare for all. This can become a problem so large that the undue economic burdens placed upon the Government and the future taxpayers become untenable. Will we always have the economic success to guarantee that no Singaporean will be denied of medical care due to the lack of means? Are we prepared to become a healthcare welfare state? No. 5.30 pm Just one episode of severe illness requiring intensive care and recuperative stay in hospital can cost more than $10,000 even at current C-class bed charges. For those with chronic illnesses, substantial amounts of money may be needed for fairly frequent long term hospital stays. Sir, at the moment the total amount of Medisave which our CPF members need to set aside is $20,000.”
“Sir, at the moment, the use of Medisave is limited to payment of expenses in the acute-care general hospitals. The use of Medisave should be extended to bona fide MOH-approved nursing homes. Sir, I would like this House to consider the following often mentioned factors: (a) We are now expecting people to live longer, even beyond 80 years of age. As such, there will be an increasing number of patients with chronic illnesses and most of them would be requiring mainly, if not, only care in nursing homes. Using Medisave and MediShield would certainly ease the heavy burden tremendously. (b) Obviate the need for some patients opting for the more expensive hospital beds. The general preference of most Singaporeans using Medisave instead of cash is indisputable and understandable. Just so that the bill may be paid through Medisave, an acute care bed is wasted and at higher cost too. (c) The general and even the community hospitals would have lesser problems at discharging the less critical cases. The patients and their families would be happier because there is, at least, some sort of continuing care made available to them. Sir, in view of the above considerations, may I urge the Minister for Health to look into this matter. Sir, may I continue with my next cut on affordability?”
“Sir, can I make one clarification? Can the Minister tell us whether the hospital doctors are now given the correct recognition and time to do research and teaching?”
“Second, does the Ministry of Health have any plans to reduce the foreign intake and recruitment of both doctors and nurses? If not, foreign doctors and nurses may end up competing with our local doctors and nurses for work when overall demand for health care goes down. I hope the Minister will clarify these two points.”
“Sir, we are a small and unique nation. We are more amenable to change things for the better, of course, without disrupting the lives of too many people. In terms of healthcare, I feel that to further integrate the public and private sectors and to have them functioning cohesively, would be a worthwhile change for our people. Mr Choo Wee Khiang (Jalan Besar): Sir, let me first commend the Minister for Health for having taken prompt action to meet both the short-term and anticipated long-term shortfalls in healthcare manpower. I note that the intake of medical students into NUS was increased from 150 to 180 last year, and will be further increased to 200 this year, so as to meet the increased long-term demand for doctors as our population grows older. I also note that our public sector hospitals have been actively recruiting foreign-trained doctors and nurses in order to supplement our local supply of healthcare professionals and meet the current shortages. However, I learn from recent press reports that the regional economic crisis has been taking its toll on the healthcare institutions. Private sector hospitals have reported decreases in their occupancy rates. I have also read of private sector specialists who say that they are seeing fewer foreign patients now than they used to. Sir, in view of the fact that overall the demand for healthcare services appears to have declined, I would like to ask the Minister for Health whether his Ministry is rethinking its long-term strategy and projections for the supply of doctors and nurses in Singapore. Firstly, will the increase in the local supply of doctors and nurses result in an oversupply, in view of the current economic climate?”
“Perhaps the solution here may lie with softening the line of demarcation between the private and the public sectors of our health service. Allow the more senior doctors a choice for proportioned and responsible commitment in both sectors if they wish. (3) The medical officer dilemma. What options are there for the senior medical officers? If not private practice as a general practitioner and if not into a specialist trainee post, what is there which the public sector can offer on a longer term basis? There is a need for some sort of career enhancement in this aspect. Perhaps, a new work schedule, a new pay scheme and a new hospital status could create a new mindset and a new breed of doctors. If more medical officers can be induced to stay back because they can see a worthy future as a career medical officer, there will be a resultant positive effect. There will be less on-call nights, less pressures in not being speciality trained, less urgency to leave for full-time general practice. In this latter aspect, perhaps the more senior ones may also be given a choice for proportioned and responsible private sector as partners or as locums in the GP clinics. Secondly, the often lamented vacuum of continuity in the teaching of junior doctors by the more senior ones in the hospitals can worsen. The teaching and training of our junior doctors needs to be maintained or our standard of healthcare will be severely compromised. The deficiency of capable teachers can only be resolved if: (a) the system allows for more scope and better rewards for those who like to teach and to do research, and (b) more senior doctors who need to explore their prospects in full-time private practice are obligated to contribute a certain amount of their time towards the public sector.”
“Sir, it seems that there is an enigmatic exodus of doctors from our public hospitals every year. This has led to a shortage of doctors and a vacuum of continuity in terms of teaching from the seniors to the juniors in these hospitals. We should try and clear this problem promptly, especially when our healthcare facilities are in the midst of rapid change for the better. Before going on further, I would like to state that I am a doctor in private medical practice and do not have any direct or pecuniary interests in this matter. Firstly, the shortage of doctors in the public sector has to be resolved. This shortage means over-working the doctors in the hospitals. Job-satisfaction is lost and morale is diminished. This, Sir, is not fair to the doctors and is also not good for the patients. The quality of care that we expect in our hospitals may not be maintained, let alone improved, under these circumstances. Unsatisfactory work-terms must be the reason for the often-mentioned exodus of doctors from Government service for private practice. What are the problems facing the doctors here? Perhaps the following factors ought to be looked into: (1) Unmatched long and tedious working hours in relation to remuneration. Well, this will always be a stumbling block for the public service. However, it should be the easier of the problems to resolve, and it should be resolved in conjunction with a whole new attitude towards the healthcare service in Singapore. (2) Uncertain prospects for their future in the public sector. The consideration of a lower income potential together with the fear of being phased down at a time when the energies are lower for striking out in the private sector, may be a reason for people to leave public service sooner than later.”
“We have to reach out to the people and increase their awareness for this need. 5. The attitude and the mindset of our people in relation to affordable healthcare in Singapore has to be reviewed in the light of our increasing affluence and expectations. And, if we have to address the need for change in order to cope with a litigious public, it is likely that affordable healthcare may be jeopardised. When doctors and other healthcare providers are given to over-investigating and to over-treating the patients because of pressures from patients and because of fear from litigation, healthcare cost must increase and affordable healthcare, as we know it, will be impossible. Sir, I feel that we are very fortunate here in Singapore. We have the means to afford a world-class healthcare service for our people. Indeed, we do have an abundance of what the medical world can offer and we do have some very good hospital facilities. Let us make sure we get the mileage from them. With that, Sir, I support the annual Budget Statement.”
“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 share-care schemes and remunerated by the Government in a reasonable and controlled manner to ensure affordability. The advantages from such schemes would be the significant savings on cost, the decreased demands on the hospitals in terms of beds and medical staff, but more importantly, the positive effects of having patients continuing to stay in their own homes with their loved ones. Thus, some sort of managed-care scheme between the general practitioners and the Government may be the way to go. 4. Preventive medicine as the key to 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 cost of healthcare. Mr Speaker, Sir, this is especially so when there are increasing numbers of elderly folk. Now, for this group of citizens, I would like to again suggest that for the best results, "preventive care" should be started as soon as possible and through centres utilising a "total-care" concept. In other words, these Centres of Activity for Retired and Elderly (CARE) should cater for the physical, the mental as well as the social well-being of each elderly. For the general population, I would like to suggest that we increase mass public education on preventive healthcare and enable easier access to regular health screening tests.”
“Sir, the likes of our existing restructured general hospitals are both expensive to build and expensive to run. A small country like ours should not need any more of them. We should, however, look into building more community hospitals instead. They will be cheaper to build and definitely cheaper to run. These hospitals will be much needed to treat the increasing numbers of elderly sick who usually require longer hospitalisation because of chronic illnesses. These community hospitals will be more accessible and more suited to provide better and cheaper care to the chronic sick. If we have sufficient beds to cater for these chronic sick, we will not waste the expensive acute beds in the general hospitals. 2. There should be enhanced collaboration amongst healthcare personnel and increased cooperation between the various restructured general hospitals. This is important for prevention of excessive duplication of under-utilised facilities and personnel. Wastage of resources in terms of equipment and of doctors and other personnel becomes significant when we have multiple centres for each and every speciality or discipline. The problem of finding medical staff to run all the general hospitals, especially when we are continually facing shortages of trained manpower, can become insurmountable. The fact that there is just not enough case material in some of the specialities or disciplines to go round at any one time compounds the problems. Mr Speaker, Sir, competition for excellence is desirable, but "fighting" for patient-load is not. 3. We should look for more practical and prudent ways to integrate and tap all sectors of our available healthcare facilities.”
“Mr Speaker, Sir, thank you for allowing me to join in the debate. The regional economic crisis is certainly taking its toll on everybody. We are facing a period of uncertainty. Indeed, this is so even to predict the economic outlook for Singapore in the months ahead. It is therefore prudent for the Minister for Finance in his Budget Statement to have said, "we are keeping a tight lid on operational expenditure". In this context, Sir, it is a good opportunity for us to redouble our efforts at efficiency and economy. I would like to draw attention to this in terms of healthcare cost in the future and the need for its containment. The continual escalation of healthcare cost, real or apparent, is of much concern to most Singaporeans today. And, although our country has not faced excessive hikes in healthcare cost, as in the United States, for instance, we need to be prepared for cost-related problems to contend with. This is especially so in terms of secondary-level and tertiary-level healthcare requirements. Sir, this is as good a time as any to review our system and look for ways to contain further rapid increases in healthcare cost and to maintain the high-quality care we now have. There is no simple solution. We should be prepared to re-evaluate our present system with a different mindset and be prepared to tackle the problems with new perspectives and through multi-approach ways. What follows are some aspects in our system that merit our immediate attention. 1. There should not be plans for more new restructured general hospitals for a while yet; we certainly have sufficient of them now. Building more new ones will only cause further duplication of the various disciplines which frequently leads to wastage of resources.”
“Sir, may I ask the Minister whether he will consider providing structural allowances for future installation of ceiling hoists which are useful aids that link the bedroom to the bathroom so that the weak elderly may move about independently?”
“May I ask if the Ministry is in favour of the setting up of an autologous blood banking service, if necessary, by a private enterprise?”
“Sir, I am not referring to autologous blood transfusion which is now available for surgery. I am referring to autologous blood bank for the general public where blood can be stored for use in emergency at any time in the future for a period of up to about 10 years.”
“I just want to ask him whether he will consider other incentives now.”
“Just one clarification. Can I ask the Minister this question? My point is that the promotion of larger families for the last five years has not made any impact with all these tax rebates.”
“But I would think that a Singaporean, with commitment towards his country, will be a better option than a newly arrived foreigner. And I would like to think that any of our women would be able to bear us children for these categories of workers. Sir, having more talented foreigners immigrating here is not a bad thing at all. In fact, by mooting this idea, the Prime Minister has ingeniously fixed several of Singapore's potential predicaments. But the way I see it, although foreigners can contribute to the dynamism of our economy, they cannot quickly and easily duplicate the kind of ties which a locally born and bred Singaporean child brings with him into our society. These are the roots which build a nation. Without these roots, Singapore is nothing more than a temporary stopover, a little more like a hotel, a little less like a home. So, let us give all our working women more incentives to have more children. At the very least, let us give them that third child maternity leave. In conclusion, Sir, encouraging "three or more if you can afford it" is the way to go. But I think it is time we gave a little more help for the journey. Let us at least offer third child maternity leave. In the longer term, our nation will benefit from getting the extra citizens. And especially so when we need to prevent the unfavourable projected dependency rate of 1 in 2.2 by the year 2030. Any improvement to this figure will be very welcome indeed. The resulting increase in population will add more young men to support and to defend the country besides adding more child-bearing and working women. Sir, please consider that not only do we gain this, we also gain one further step towards graciousness in our 'best home'.”
“For the first point, I contend that if the worker really wishes to have a third child and is not provided maternity leave, she may very well resign from her job anyway. Someone has crudely calculated the annual cost of granting two months of third-child maternity leave. The estimate of between $35 million and $45 million is possible. This is based on a statistical finding that 4,000 of the 9,000 third-child mothers are working and on the assumption that either all of them have a monthly salary of $5,000, or more than likely, 2,000 of them have a monthly salary of $5,000 and the other 2,000 have a monthly salary of $2,000. So, even if we err on the high side of the estimate, the cost to the industry in monetary terms is about $45 million. This figure is not large if we consider the long-term benefits derived from the increased population growth and from the satisfaction and dignity given to our working women. 'Economic Growth' Viewpoint The Government has suggested that we allow more qualified foreigners to immigrate here. Having more talented people living and working for this country will enable us to gain and maintain global competitiveness. Recently, the Minister for Home Affairs also highlighted that we have a birth rate which is too low even to replace ourselves, let alone increase our population. He also said that " . since Singapore cannot produce enough people to come into the workforce each year, we need foreigners to sustain economic growth .". Now, all this means that we do need more people. But, significantly, it was also suggested that we do need more people at all levels, including those in the low-skilled and semi-skilled categories. This being the case, I think it matters not any more who provides us with the increased numbers of people.”
“For the past five years, the number of third child birth has been constant at between 8,000 and 9,000 each year. Noticeably, about 5,000 of these third order children every year were born to non-working mothers. My impression is that any change of policy will have no influence over this group and we will, in fact, favour the working and presumably higher income group when they contribute that third child. It is noteworthy that consistently over the last few years, slightly more than half of those who bore a third child had a secondary and/or higher level of education. And, it is significant that slightly more than four-fifths of those who worked, held jobs as service workers at the very least. I feel that third-child maternity leave will induce and encourage our economically active women to stay in their jobs after the second child birth and to go for that third child. This will give us that much needed increase in population for the future. There is an argument that the higher income and better educated group of women is in a better position to bear and to bring up successful and stable children. There is also an argument that, whereas third-child maternity leave will favour everyone equally, enhanced tax relief will favour and give this group some added incentive. Fair points, and perhaps true too. But we do notice that even of late in Singapore, scholars and super-achievers often come from lower income families. Their parents may even have no formal education at all. 'Economic Loss' Viewpoint The cost to industry, as a result of third-child maternity leave, should not be considered an unnecessary inconvenience in terms of manpower loss. And, it should not be considered exorbitant, at present wages, in monetary terms.”
“I do not want to be unrealistic; let us consider granting this leave, at least to the third child birth for the time being. 'Population Policy' Viewpoint The birth rate in Singapore has been stagnant for the past five years. It remains at about 50,000 per year despite tax incentives to encourage procreation through the revised population policy of 1987. Although the removal of the various disincentives may have helped, it does seem that the Third-child Special Tax Rebates (modified over the years of 1989, 1990, 1993 and 1997) are not sufficient to provide any significant effect on increasing the birth rate. I think the reason for this lies in the fact that Singaporeans nowadays are more rational and are very much more responsible. Singapore has to maintain high standards in order to retain its success. And, in trying to achieve this, life can sometimes be pressurising. The concerns of the people are mostly about good and successful upbringing of their children. They are not about to have more kids just because of monetary benefits alone. Furthermore, with all that generous GST rebates and additional income tax rebates, I would say a larger number of our working women need to pay little or no tax. In other words, they get no added incentives at all. The responsible Singaporean mothers may just let our birth rate fall again unless we give them all the support we can afford. 'Higher Education and Higher Income Mothers' Viewpoint Statistics have shown that the more educated mothers tended to have higher income. They also tended to have fewer children. I feel that the third-child maternity leave is more likely to benefit this group of mothers and should therefore be granted if we are targeting them to go for that third child.”
“Mr Deputy Speaker, Sir, I like to raise the issue of the third-child maternity leave although I am aware that this has been brought up for consideration many times before. I beg the indulgence of all the Ministers, especially the Minister for Labour, and the Members of this House to hear me out and consider the reasons I have for testing their patience with this issue one more time. I believe that the reason for not granting third-child maternity leave hinges on the basic tenet of "have three, or more if you can afford it", and that affordability is reflected by the ability to circumvent `lack of leave' with `gain from tax relief' and by the ability to incur minimal or no economic burdens upon the employer and the nation. Sir, perhaps the time has come for us to reconsider these measures and consider other aspects of best home ideology. Let us also look at non-economic terms and allow our women folk a `less pace, more grace' life. I am aware that our population policy and labour force status have to be carefully monitored and managed. However, I feel we are obliged to continually review the state of affairs and see if we can do a little better. Sir, please consider my five viewpoints concerning third-child maternity leave. `Basic Right' Viewpoint I have heard of instances where employees are not even allowed to apply for no-pay leave for their third-child delivery due to shortage of manpower. This is a totally deplorable state of affairs for the women. It saddens me that we are unable to grant a very basic right which every new mother deserves in fulfilling one of her natural roles. Confinement is really a necessity for the new mother to recuperate and it should be regarded as a right and not a privilege.”
“How is the patient going to know what constitutes an emergency and is it fair to penalise the patient for misjudging the severity of his illness?”
“May I ask the Minister where can the patients go but the A&E departments of the major hospitals when they fall ill in the middle of the night and are not the night clinics too few and far between to be an alternative facility to the A&E departments?”
“Can we do improvement in that area because by the time they complained, scarring and abnormality are permanent by that time?”
“Can I clarify? Can the Minister tell me how does the Ministry monitor unauthorised people practising medicine, for example, using lasers, injections and other instruments on the patient?”
“Yes, we want medical excellence but we must still retain some respect and compassion for human expectations and limitations. Please do not subject doctors to go back to "school" and do examinations every two years! Well, I am sure the authorities will not have such unfair and authoritative demands. Sir, I support the Bill.”
“I would like to suggest that specialists can register themselves into broad categories. Registration under sub-specialities should be carefully chosen and limited. I would also like to suggest that whilst it may be unwise for a specialist to perform cross-speciality work, their practice of medicine should not become so restrictive that their basic tenet as a doctor is lost and forgotten. In other words, they should still be able and be entitled to treat simple ailments, such as flu, diarrhoea, headache, and so on, in their patients without having to refer them elsewhere. Excessive and unnecessary referrals will only increase healthcare costs. Clauses 36, 37 and 38 in the Bill are new and concern the introduction of a Practising Certificate which will be granted to every registered medical practitioner. The validity of this certificate is for a period not exceeding two years from the date of issue. In future, the Medical Council will have full control over the practising doctors in Singapore because the application for a Practising Certificate shall be made in such form and manner as the Medical Council may require. This can become one control too many for the doctors. Sir, the point I want to make is that this is definitely an extra "bitter pill to swallow" for all the doctors. I would like to urge our Government to practise restraint and not to use this Practising Certificate as a tool to pressurise and to cause extra demands on the medical profession. I would also like to suggest that the Government practise prior consultation and feedback with all the parties involved before implementing new ideas as laws. This is especially for rules that can affect the livelihood of some of the doctors.”
“Many of you will be glad to know that this means that there will be lay people in the Committee of Complaints. Besides the three or more members of the Medical Council and the 10 to 40 registered medical practitioners over 10 years' standing, there will be six to 40 members from the public in the Panel. Some people have argued previously that there may be bias in the assessment of complaints from patients because the Panel is derived from medical practitioners only. This new addition in the Bill will address peoples' desire to know that open and representative assessments are carried out for all the complaints of any improper acts or conduct by doctors. It will also resolve the perception that doctors who bring disrepute to the medical profession are only subjected to "internal audits" by medical practitioners themselves. The clause provides for up to 83 members to be in the Panel. This is a large number. Perhaps this will help eliminate the element of bias and prejudice. Clause 22 of the Bill is totally new. The registration of specialists is now necessary to cater for the changing times. There was no necessity to have this clause in the past as, even just 10 years ago, the number of specialists was limited. The need for a Register of Specialists becomes obvious when we note that a whopping 40% of our doctors now are specialists. The registration of specialists will allow for the public to be better informed on the availability of the specialities and the specialists. Also, this will enhance the reputation of Singapore as a centre of medical excellence with a large number of specialists in wide ranging medical specialities. This will certainly boost the promotion of Singapore as a major medical centre in this region.”
“He was accused of performing colon-cleansing amongst other health treatments on patients between 14th and 18th January this year. This colon-cleansing procedure can be dangerous and did result with perforation of the colon in one person. It is possible that unqualified practitioners will do any procedure and some of these could even be life-threatening. The case of a bogus doctor who worked in the General Hospital last year for more than six months is another example of note. Sir, perhaps it would be prudent for us to delineate clearly the sort of treatment which practitioners in traditional medicine or beauty-care should not be administering so that they do not unwittingly violate the law. The maximum penalty that can be meted out to any unqualified practitioner in medicine or surgery was a fine of up to $500 and a further fine of $50 for every day during which the offence continues. This indeed is absurd and, especially, when even cruelty to animals is punishable with both a fine and also a jail sentence. The potential mental trauma and danger to life should not be punishable by a mere pittance of a fine. This Bill now provides that an unauthorised person acting as a medical practitioner shall be guilty of an offence and shall be liable on conviction to a fine not exceeding $100,000 or to imprisonment for a term not exceeding one year or to both and, in the case of a second or subsequent conviction, to a fine not exceeding $200,000 or to imprisonment for a term not exceeding two years or to both. I return now to clause 39(1)(c) of the Bill which requires the Medical Council to appoint not less than six and not more than 40 lay persons as part of its Complaints Panel.”
“Mr Speaker, Sir, I rise to speak in support of the Medical Registration Bill. As I am a medical practitioner, I would like to declare that I do not have and do not anticipate to have any pecuniary interest through this Bill. On the whole, this Bill is comprehensive and is suitably up-to-date for the immensely changed scene in the medical profession. I must say that the introduction of this Bill to modify the Medical Registration Act is very necessary and is very timely. It is to be noted that a number of amendments and additions are broad-based. This is appropriate in view of the present state of rapid change. I reckon that room for modification is necessary so as to have adequate and better control of the whole profession when newer developments take root. However, I would like to seek assurance from the Minister that, when they are being finalised, the details of these amended and new clauses will not unnecessarily prejudice or penalise any particular practitioner or group of practitioners. Sir, I would like to highlight and comment on a few of the new clauses in the Bill. Firstly, Sir, I note that clause 17(1) in the Bill has been amended from the previous Act to deal with the offence of acting as a medical practitioner by any person who is not authorised to practise medicine. I welcome this long overdue amendment. This clause would now enable the authorities to more effectively address a few unfortunate situations which happened recently and which many felt were not adequately dealt with. For instance, as mentioned by the Minister for Health earlier on, a 57-year old man was charged in court this month for practising medicine without registration.”
“I hope that the Minister can seriously consider this proposal which can "kill three birds with one stone".”
“We found that out of 48 RC centres, 47 of them, or 98% do not provide services in the day time. The RC centres are not open in the day time for two reasons. Firstly, the RC members are all volunteers. They have their own work to do in the day time. Secondly, RCs are non-profit making organisations. They do not have the financial means to engage staff to work in the day time. As a result, most of the RC centres are not open in the day time. Sir, I would suggest that in keeping with the formation of CDC, we should make full use of all the facilities in the 486 RC centres as liaison centres. They should be open all day long, and staff should be engaged from retirees who are experienced or from housewives, to undertake part-time work in such centres to serve the residents in the day time. There are three advantages. Firstly, it will put the facilities of RC centres to better use as venues for activities. Secondly, we can engage some retirees or housewives to undertake part-time work in these centres. As a result of our aging population, we should explore opportunities of employment for our senior citizens to solve some of their problems of livelihood. On the basis of $5 per hour for the part-time work, I think all the 456 RC centres will be able to provide, say, two jobs for part-time workers and thus a total of 1,000 job opportunities will be created for these retirees and housewives. Thirdly, the RC centres are all housed in the void decks of HDB flats and they are within the RC zone. So it is very convenient to the residents, especially to the senior citizens and the aged people. When they need the help of the CDC, they can just walk a few steps to go into the RC centres. It is very convenient for them. This is the best way to serve the people who need such services.”
“Hougang CCC, on knowing that our Town Council is going to make this improvement, made a duplicate application to HDB for the CIPC funding. This is wasting resources. So, are they actually serving the constituency or are they serving the PAP? If the grassroots organisations are serving the PAP, they should be re-classified as a PAP branch, so that they could do grassroots work for PAP. They should not be hiding behind the People's Association and make use of our people's money and claim to be enhancing social cohesion, but actually they are just trying to help the PAP attain its political target. Mr Ang Mong Seng (Bukit Gombak)( In Mandarin): Sir, Singapore, since its independence after 32 years of hard work and struggle, has developed from a developing country into an advanced industrial economy. We have made this achievement because of three major factors: (1) political stability; (2) economic growth; and (3) social order. Social order is the basic pre-condition for economic growth. At the same time, we must also thank the People's Action Party Government for its far-sightedness in setting up grassroots organisations in the 1960s, such as the CCCs, CCMCs and later the RCs, and also encourage the communities to set up clan associations and other civic organisations to carry out various community activities to enhance our own spirit of social cohesion, regardless of race, religion and language. We have set up a good network of grassroots organisations. A total of 456 RC centres have been set up as venues of activities, such as reading newspapers, watching TV, conducting courses and other activities to provide better services to the residents. Recently, I conducted a survey among RC centres in the north-western part of Singapore.”
“I thank the Minister for his reply and I beg leave to withdraw my amendment. Amendment, by leave, withdrawn. Mr Low Thia Khiang( In Mandarin): Sir, I beg to move, That the sum to be allocated for Head J of the Main Estimates be reduced by $10 in respect of Code JH 3100. 1.15 pm Sir, the People's Association was formed with the objective of promoting social cohesion among our people. However, are the grassroots organisations under the PA set up to enhance social cohesion, or to serve as a tool for the People's Action Party to attain its political purpose? Take my constituency, Hougang, for example. In 1995, when the Hougang Town Council applied to the HDB to install illuminated directional signboards at the car parks, we thought the Hougang Citizens' Consultative Committee, which is part of Hougang, would be glad to support our application to the HDB for Community Improvement Projects Committee (CIPC) funding. Therefore, in September 1995, the Town Council wrote to the CCC about the said plan and asked them to support our project. But the Hougang CCC not only did not support our project, they themselves submitted an application for this project. Because of this, HDB said that there was a duplication in application and delayed the approval of this project for more than 2(r) years now. Such interference by the Hougang CCC resulted in a delay in this project. In April this year, the Hougang Town Council again wrote to the Hougang CCC to inquire on this matter. Up to now, we have not received any reply from them. So I would like to ask the Minister in charge of all the CCCs in Singapore whether the Hougang CCC is still interested in proceeding with this project which has been delayed for more than 2(r) years.”
“Sir, I beg to move, That the sum to be allocated for Head J of the Development Estimates be reduced by $10 in respect of Code JD 5100. Sir, the community has gained in many areas through MCD. As we are one of the fastest-aging nations, I am glad that MCD has done a lot for the care of our elderly and I am also glad that the Finance Minister has made allocation towards the needs of the elderly. Sir, we have the medium and the means to look after our elderly well. We only have to find the best methods. "Preventive care" is widely accepted as the best way to go. It is the key to successfully contain the high cost of looking after our increasing numbers of elderly folk. For best results, I would like to suggest that "preventive care" should be started as soon as possible through centres utilising a total care concept. In other words, the Centres of Activity for the Retired and Elderly (CARE) should cater for the physical, mental as well as the social well-being of each elderly. Therefore, we will provide them with daily exercises, wholesome meals, regular health talks and health screening tests. We will get them to participate in various social activities, to take up some hobbies and to go on outings. Furthermore, we will get them to interact and to form "buddy" groups so that they care and help each other. Sir, I know that MCD already has many projects in operation catering for the needs of the elderly. My question, Sir, is whether MCD would modify some of these projects towards the total-care type. For instance, we may enlarge the Senior Care Corners to provide all the three requirements. May I also urge MCD to support and promote CARE or similar projects.”
“Sir, at the moment, there are 107 before-and-after school care (BASC) centres. I believe we do require only 60 more of them. Sir, I feel that there is an urgent need for us to have these centres set up as soon as possible to make up for the shortfall. Whether women continue working is frequently based on whether they can leave their children somewhere safely. BASC gives peace of mind to such parents who, while they work, know that their children will be fed, supervised and encouraged to make proper use of their time both at homework and at recreation. We do want to increase our workforce. BASC centres, in similar ways as childcare centres, can entice more parents contemplating looking for jobs. These parents, becoming economically useful, will definitely benefit themselves, their families and the country. Added on to these factors, the noticeable and increasing trend towards delinquency and towards children going astray, only to be recruited into gangs, is disturbing. Our children are extremely vulnerable during their tender years and they can easily adopt unhealthy habits and wrong attitudes if exposed to wrong company. We have to prevent this and before-and-after school care centres can be one of the avenues we can make use. Sir, does the Ministry have plans to set up more BASC centres or to offer extra incentives to schools and grassroots organisations to set up these centres? May I also urge the Ministry to please consider having these centres built at an increased rate?”
“Sir, there are presently 434 childcare centres in Singapore, each one professionally run and giving the sort of care that allows some women to go out to work in peace and some women to even contemplate looking for work. These centres are to be praised for better education to the young and for better integration among the children. However, there is a need for more childcare centres. It has been estimated that we will require a further 2,000 places each year in the next three years. This would mean adding more centres each year. My question, Sir, is whether we should not now aim to have new centres better located and soon to be renovated ones decentralised and relocated. By this, I mean each centre could be of a smaller scale and is to be within short walking distance from the homes of the children. I feel that neighbourliness and social integration among the residents can come to play more significantly if residents from the nearby blocks can have a share and care attitude for each other. A grandparent or even a neighbour can conveniently mind the child should the need arise. Thus, would the Minister consider decentralising and having more smaller-scale but precinct-located childcare centres? The inability to entrust their young children to someone somewhere is a likely reason for working women to avoid early motherhood and more children. The majority of childcare centres have two years of age as a minimum acceptance age. Therefore, would the Minister also consider having centres that accept children less than two years of age?”
“Yes. My question is that I would like to ask the Ministry whether, apart from those geriatric departments in Alexandra Hospital, Tan Tock Seng Hospital and New Changi Hospital, will new ones be established in the other acute general hospitals in the near future? Sir, my last topic is on geriatric training and services. There is a shortage of geriatric care providers even as of now. By the year 2030, it is likely that almost one-third of our population will be considered elderly. In view of the increasing trend in the population of our aged, we certainly have an urgent need to increase our pool of people who are interested in gerontology and trained in geriatric care. We will need more geriatric specialists, trained geriatric-care nurses, physiotherapists, speech therapists and so on. This has to be looked into now if we are to aim at providing the most effective and best care for the elderly in the future. I would like to ask the Ministry whether there are already plans in place for the training of people to solve this shortage. Time is needed for training people, just as time is also needed for comprehensive planning of the services. This has to be an on-going process started from now to have the basic resources in steady-state. Sir, unless we have these core service-providers, we cannot make any substantial progress in the care of our elderly, especially when it comes to looking after the dependent elderly, the lack of core service providers will be our stumbling block. Geriatrics, as a specialty, is not a popular career pursuit among doctors. This trend needs to be addressed. Will the Ministry be seeking ways to entice more young doctors to train in this particular specialty?”
“My next topic is on the setting up of more geriatric hospitals. The sick elderly are best catered for in geriatric departments or geriatric hospitals where a more holistic approach towards better care becomes possible. The elderly are often afflicted with multiple illnesses, and when they go from one specialty to another, they are often subjected to multiple diagnostic tests. They may be over investigated or over treated for conditions that are in fact due to the normal processes of ageing, which in isolation and in an acute hospital or emergency situations can complicate diagnosis and treatment. Well-run geriatric departments can prevent such unnecessary inconvenience and waste of resources.”
“Sir, the most effective way to the care of our elderly follows the dictum "prevention is better than cure". In view of the increasing numbers of our elderly to about 850,000 over the next 30 years, preventive care should be promoted island-wide on a big scale and soon. Let it be made available to our elderly while they are still well. There are quite a number of preventive care concepts or models. I have started a model in Kim Seng which is based on a "total care" concept of looking after the physical, mental and social well-being of the elderly. By paying a reasonable and affordable fee, the participants sign up at this precinct-located Centre of Activity for Retired and Elderly (CARE) for their daily exercises, wholesome daily meals and social activities such as singing, dancing and picnic outings. They get to interact and befriend each other and, hopefully, they can be concerned for and be helpful to each other as "buddies". They will attend health education talks and have health screening tests which are to be conducted yearly for them. Sir, I am convinced that the way to go is to have more of such CARE. They can be run by grassroots groups and organisations from the community. They do not cost much to run, but they do need support. Sir, by spending time and effort and money on preventive care now could save us dollars up the road in a big way. I would really like to see the involvement of MOH, MCD and CDCs in supporting such centres. At the moment, several private volunteer doctors are providing some of the services. But MOH's involvement would enhance and maintain the fast increasing demands. Could MOH support these types of centres, especially in terms of back-up medical screening tests and regular health talks?”
“Sir, may I take all my three amendments together?”
“Mr Speaker, in the President's Address, the question of Singapore's ties with the countries in this region and with the world had been touched upon. As a small nation with a network of ties throughout the world, Singapore has always practised a foreign policy aimed at fostering cordial ties with all countries. As far as I can remember, the Government has always given priority to ASEAN interests in managing our foreign policies. But sometimes there are obstacles and challenges. An example is, for almost three months now, Singapore-Malaysia ties have not been as good as before. In fact, it could be said that ties have been in a mess. I do not see how anyone could profit from this situation, except perhaps ---[Mr Chiam See Tong entered the Chamber.] An hon. Member: Repeat your second point. Encik Mohamad Maidin B P M( In Malay): Mr Speaker, there are two matters which I raised just now. So I will return to the second point, that is, Mr Chiam had proposed an economic union with Malaysia saying that during the years that Singapore was in Malaysia, Singapore had benefited economically. I checked in the library just now and found that in 1964 when Singapore had a full-year in Malaysia, we underwent negative economic growth of minus 2.7%. So I do not see any basis in Mr Chiam's opinion that the economic union is a good factor for Singapore to consider. But since Mr Chiam is convinced that this is a good idea, he should raise this matter with the relevant authorities in Malaysia and obtain their reactions and if they are interested, he could then raise this matter so that our Government could take follow-up actions to look into this idea. I hope he could give some attention to my proposal.”
“We know that in every housing estate and constituency the people are given a choice to choose whether or not they want to have upgrading. The choice has been given to Singaporeans and they have made their choice. The second matter that Mr Chiam touched on concerns economic union with Malaysia in which he reiterated his stand in the SPP which he formed with his friends not too long ago. I heard with care just now that Mr Chiam found that when Singapore was in Malaysia, we had a sort of economic union with Malaysia, Singapore's economy grew rapidly. I was able to go to the library of Parliament and found that from September 1963 when the Malaysian federation was formed involving Singapore, the Peninsular, Sabah and Sarawak, up to our separation from Malaysia in August 1965, between these two dates, in 1964 Singapore had a full-year in Malaysia. I found that our economic growth was negative, that is, minus 2.7%. This posed a question mark as to how Mr Chiam based his economic view that being in the union would benefit Singapore more. However, as I think that he is very serious about this union, Mr Chiam and his party should bring this matter to the interested parties in Malaysia and try to find out their opinions. Should this idea be found attractive, perhaps Mr Chiam could raise this issue to the authorities and government to carry out follow-up actions to study the feasibility as to whether this economic union is beneficial to both Singapore and Malaysia, and to see how this idea could be expanded to an association like ASEAN. I think Mr Chiam has to look into this idea further before we can improve on it or go further and be accepted by the Government.”