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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“Good policymakers must also be good communicators. Skills in communicating are worth pursuing to equip everyone Page: 12 in charge of policymaking. The following are the essential components of communication skills: (a) produce clear, persuasive and accessible communication products; (b) use the most effective and appropriate channels and technologies to deliver communications; (c) understand policy priorities and leads on the transformation of organisational communications; (d) understand, respond to and satisfy communications needs of diverse audience; (e) plan, build and manage delivery of strategies, campaigns and day-to-day marketing and communication services, and (f) gather and interpret data on the effectiveness of communication strategies, campaigns and services and their impact on audience behaviour and outcomes as well as identify improvement opportunities. Mdm Speaker, the success in communications is politically as important as the success of the policy itself. Public satisfaction, trust in Government and good governance are not interchangeable concepts. Rather, trust and satisfaction are better conceived of as necessary parts of a set of indicators for good governance. Mdm Speaker, let us chart a new chapter with the Opening of the Second Session of the Twelfth Parliament and strive for better governance. 1.44 pm”
“Considerations should also be given to the vulnerable groups of the society. These groups, Mdm Speaker, may be the silent majority but their interests, though usually not expressed, must be registered. This calls for good governance to ensure fair redistribution to benefit the majority and the vulnerable groups of the society. This also calls for good governance on efficient use of the limited resources to prove their value. Fourthly, mitigating public expectations with better communication. I personally like the concept of "shared decision-making" as an approach to mitigate public expectations. Madam, this approach will lessen the challenges of demands that cannot be met. In medicine, it is used as the means to achieve a higher quality of care and more effective outcomes, as well as rebuilding trust between clinicians and patients. The concept of "shared decision-making" or "partnership" implies joint responsibilities as a result of active engagement of citizens in deliberation about public policy. The end result of successful deliberation will be more likely to prevent the anomaly of "mismatch between perceptions and realities" or "paradoxical outcome" situations. The paradox arises because the public does not believe in, or does not know about, objective improvements in service quality. This is the situation where improved performance is not reflected in rising satisfaction levels. This may be due to unrealistic public expectations of services or due to communication of service improvements being ineffective. The failure here is not with service provision, which has objectively improved, but with the public's understanding. Policy needs to be supported by a well-designed communications strategy. At the end of the day, Mdm Speaker, it all comes down to communication.”
“The study and research for example should examine: (a) what aspects of service performance the public sees as important to be satisfied with; (b) the influence of social interaction on citizens' expectations, and (c) what the public values, whether they really are rising, and how they can be more effectively managed. It will also be useful to have a data monitoring system to examine satisfaction levels, which can be used to improve services. Components of such satisfaction data are: (a) identify priorities for improvement; (b) determining citizens' priorities; and (c) identifying key satisfaction drivers and priorities regarding what to improve. Satisfaction data can be used to set targets that focus effort on outcome measures, the wishes of citizens and adaptability to changing conditions. Benchmarking performances of various Ministries on satisfaction data can be used to benchmark the performance of different Ministries. Page: 11 Thirdly, prioritising meeting public expectations. There are always situations where Government's response to public expectations cannot be met satisfactorily. This might be because of competing demands between the needs of service users and those of taxpayers. In such situations, there may be a need to "damp down" public expectations. An example would be subsidising World Cup telecasts. Our Government is facing increasing diversification of public demands and our resources are finite. There will be times and situations where citizens' satisfaction should not be the binding goal. For example, there will always be groups of people who would argue that the expenditure on defence and national service is unnecessarily high. Policy priorities on the use of limited funds should be accorded to those that can benefit the majority of the population.”
“Thus, has this Government been inflating public expectations? For example, we prided ourselves to have the best airport and the best transshipment port and so on. Going forward, should we always strive to be the best in these areas and at what cost? Is there a need to change the stance of our Government in order not to heighten public expectations further unnecessarily? Going forward, should we adjust and set realistic expectations? It demands continuous maintenance, resources and demonstration through good practices, in order to maintain our excellent reputation. Much of our resources are necessary for the maintenance of an excellent reputation; but more importantly, innovative ways must be put in place to maximise the outcome of Government efforts. Service provisions must be able to garner the approval and recognition from the populace. Secondly, public expectations study and research. Being mindful of public expectations is a timely topic in the present day where unhappy citizens are able to quickly and widely publish their experiences online. Mdm Speaker, there is a need for us to deliberate on this issue. It will be good for the Government to do research on this issue in depth. It is necessary to involve all Ministries to study their own uniqueness in these areas and to formulate their own strategies. The final evaluations can then be adopted as a policy going forward. This is to ensure that people can appreciate what each Ministry is doing, rather than finding fault with it.”
“Mdm Speaker, at this debate to mark the reopening of this Twelfth Parliament, I want to raise an important issue facing this Government going forward. This is the issue of "rising public expectations and its challenges". It is a fact that public expectations have been rising over the years, but can these expectations be met satisfactorily going forward? Are they attainable in the long run with our limited resources? Will they erode the confidence and the trust of this Government if these public expectations are not met satisfactorily? Should there be a need to prioritise certain aspects of public expectations for the common good of all? Madam, public expectations cannot exceed available resources, statutory responsibilities and institutional capacities. What are the mitigating factors that have to be considered going forward to ensure equity, diversity and choice? I would like to suggest the following four approaches. First, setting realistic expectations. Studies have shown that prior performance is positively related to expectations of what performance will be. Providing information about excellent performance frequently raises positive expectations. In Singapore, prior performances are definitely positive since this Government had always delivered on all its promises with flying colours. Good reputation usually results in little tolerance for error. Studies in psychology have concluded that the better the reputation, the higher are the Page: 10 expectations. Thus, is it the main contributory reason for the rising public expectations here? Although I am not implying that this Government should not deliver to the best of its ability. This Government had, in the past, also always emphasised to be the best achiever compared to other countries.”
“Thank you, Mdm Chair. Two clarifications for the Minister, please. May I ask the Minister whether he will take up my suggestion to better assist lower-income families to help themselves by Page: 46 adopting the hands-on approach, to micromanage each case in order to find long-term solutions for each family, especially young families? On my second clarification, the Minister earlier said that there will be assistance for retirees who are on subsistence living due to very low CPF payouts, and that now this group will be eligible for Public Assistance or ComCare. I would like to thank the Minister for that. May I ask the Minister whether he knows the number of such cases that had been rejected by CDCs or MSF for the past few years, as I had quite a few in my ward, and whether such cases now can be recalled to give them the due assistance?”
“It is very important to have better provisions to assist this group. Could MSF make available support services to give respite to caregivers and prevent burnt-out syndrome of those service providers, such as dementia caregivers, at home? May I ask MSF whether enhanced measures – either financial assistance or homecare assistance to assist low-income and middle-income families care for Page: 171 their dependent elderly members at home better – can be put in place? Maintenance of Parents Act”
“Mr Chairman, the reported cases of elderly abuse are about 200 yearly, since 2004. This number is more likely to be just the tip of an iceberg and more importantly, it is unacceptable because no person should be abused. Many abused elderly may not report for various reasons. For example, they may feel shameful, they may not want to jeopardise their source of providers, they may be too weak or too sick to protest, or they may not know the channels to get help and so on. We have the Mental Capacity Act to protect the mentally incapacitated elderly and the Maintenance of Parents Act to obtain financial support for parents from their children. Is it time to further introduce more laws to stamp out elderly abuse? The perpetrators must be brought to task with better provision of deterrents in place and laws that have more teeth to prosecute. There must be better legal protection for abused elderly, especially the infirm elderly. Perhaps, we can have an Act similar to the Children and Young Persons Act (CYPA). CYPA prescribes counselling, psychotherapy, assessment and treatment. CYPA also requires care centres to report suspected cases of abuse. CYPA protects informants on suspected cases of those being abused from personal liability. This is particularly useful to encourage social workers, relatives, friends and grassroots leaders to report abused elderly because the victims themselves usually keep their silence. There is a need for raising public awareness on elderly abuse. There are various kinds of abuses and they include infliction of physical pain and injury, debilitating mental anguish, unreasonable confinement, wilful deprivation by caretakers of services necessary to maintain physical health and mental health, as well as financial abuses.”
“As an ageing population, many more seniors will grow older and inevitably many more will get weaker at their advanced age. For those who live in rental HDB flats with no family members to depend on, ageing at home will get tougher as they grow older and weaker. Noticeably, many prefer to live in their own homes for as long as possible. Will MSF facilitate this group to age in their own homes gracefully with some form of home-help, such as food delivery, befriender service and homecare? Is there now any scheme to identify these cases, especially those living alone? Could MSF identify them and at least refer them for VWOs to assist them if MSF does not have homecare service provisions? I hope MSF can look into the expansion on this area to assist many more to live in their own homes Page: 151 for as long as possible in view of our demographic trend. Homeless”
“Page: 150 Many low-income families are in chronic need of financial assistance due to many factors. Giving them ComCare assistance will only solve their difficulty for the short term. What they really need is micro-interventions to attain a longer-term solution. We need the system to better help them help themselves. This is particularly useful for the young families. Will MSF consider taking such an approach, especially for young families in need? This method will seek out the underlying root causes of poverty and then work with the families to change the course of their lives for the better. This may be more resource-intensive to micro-manage each case, but the possible positive permanent outcome of self-reliance will be rewarding. MSF will need more staff, social workers and counsellors to carry out such a hands-on approach to diagnose, suggest long-term solutions and guide those in need to achieve the ideal outcome. Does MSF have enough staff capacity? May I ask MSF if there is still a shortage of social workers and how does MSF plan to solve this? The Social Service Offices (SSOs) have been well received. My constituency has one in Chinatown and my residents find it very useful. They can visit the SSO more conveniently and receive help faster. How are the SSOs coping thus far? How fast are the response and assistance rendered to applicants? Are the remaining SSOs – 22 in total island-wide – on schedule to operate by next year? Concerning those in poverty, especially the elderly on subsistence living, may I ask MSF if it has the figure on the number of them? I am referring to those retirees who are not eligible to receive Public Assistance and are receiving meagre monthly CPF payouts that are lower than PA amounts. How does MSF assist this group of people?”
“MSF has a slew of assistance schemes in place to assist those in need. They are good but many do not comprehend them. There is also lack of coordination and sharing of information between stakeholders to help those in need. I want to illustrate this with the following example. One 29-year-old resident came to my Meet-the-People Session (MPS) 10 days ago to collect her third ComCare cheque of $200. She proudly showed me on her mobile phone an interview, arranged by a local group, which she did last month. I first got to know of her problems last December when her third husband with whom she had five children, aged four to 11, left her. The grassroots leaders visited her and helped her with food-ration vouchers and recommended her for ComCare Assistance. We recommended her to earn some extra income through our in-house Social Service Enterprise but she turned that down. Four of her older children, aged six to 13, had been attending our CATCH Plus programme, as mentioned by Mr Seah Kian Peng earlier. This programme provides for completely free day care with the provision of meals, tuitions, computer classes, music classes and other activities also supervised by full-time staff daily. Children who got sick were sent by staff to see doctors with no cost to their parents. She was quoted at the interview saying that she could not make ends meet and she had not been able to afford asthma medicine for her second daughter who has been attending our classes for months. I referred her to MSF through the Social Service Office at Chinatown when she first approached us in December. May I ask MSF whether we can have a better system to know if one person is already being helped so that help can be more coordinated?”
“Mdm Chair, I would like to seek two clarifications from the Minister. May I ask the Minister whether he will empower people to take better responsibility for their own health by having some measures in place? One example can be incentivising MediShield premium rebate with certain ideal BMI or certain good control of chronic diseases. My second clarification is on right siting of medicine. The Minister has said earlier the importance of right siting. May I ask him to elaborate on the measures in place right now for right siting and whether we can enhance it further to have better right siting?”
“Are step-down care services incentivised enough to take the load from tertiary institutions? Are we having enough campaigns to bring out the awareness of preventive medicine? Are we having the right kind of medical care providers? For example, can we train more medical workers to take the job of nurses for homecare? This list can be non-exhaustive and we need to pursue it at all angles by all healthcare providers. Could the Minister make it a priority for all to adopt this mindset and find the best solutions? Lastly, there are increasing numbers of psychiatric cases in Singapore. Could the Minister provide better care for them? There is an urgent need to promote awareness and to remove the prejudices on mental illnesses. Are there enough step-down care facilities for those discharged from hospitals so that we avoid sending them all directly back to the community? Can there be better provision of psychiatric diagnosis and follow-up of patients living in the community? Can there be better follow-up and care for such patients in the community by psychiatric personnel and can the families of such patients be given assistance to care for their sick family members? 12.45 pm Bed Crunch”
“It is time that MOH established more and better homecare facilities. Four, sharing of best practices, preventing over servicing, maximising limited resources, avoiding duplication, better integrating public hospitals and improving productivity drive are areas that need further emphasis. MOH should facilitate and reward innovations to save costs. One important issue still remaining is for MOH to ensure the high quality of healthcare personnel, despite facing its many challenges. The training of our doctors to retain our well-known and established high Singapore standard must be preserved. Five, my concern now is that with the increased subsidy for SOCs, as announced in the Budget, whether it will drive up demand and further stretch SOCs' capacity. Correct remuneration must be in place in our public hospitals to avoid overuse on specialists' services, over-ordering of prescriptions, or over-using and over-pricing of procedures. As far as possible, we should empower people to take responsibility of their own health. MOH should emphasise and incentivise people to lead healthy lifestyles and keep physically and mentally well. For instance, can MediShield Page: 36 premiums be priced with refunds when certain ideal BMI is maintained, especially for the young? For those with chronic diseases, they can be incentivised for having well controlled diabetes, hypertension and high cholesterol. We all agree on "right-siting" in medicine or that we need to have patients treated in the most appropriate locations by medically-competent teams at the lowest possible cost. Has MOH endeavoured to have better "right-siting" so far? For example, is it correct to reward specialists in the hospitals on the numbers of patients they see?”
“A well-planned policy calls for enhanced awareness and early intervention to try to cushion the exponentially-increasing demands on our healthcare needs in the years ahead. The old adage "Prevention is better than cure" is even more apt today than ever. MOH should step up on the following areas. Page: 35 One, promotion of healthy lifestyles to prevent chronic diseases and better control of chronic diseases. Apart of strengthening the existing programmes, I feel that MOH should be more actively promoting this at workplaces targeting the young. There should be even more campaigns to promote healthy living and prevent chronic diseases. Two, at any one time, there would be some 8% of the elderly requiring step-down care of varying levels of intensity. There must be adequate step-down care facilities available to ease this transition. Such step-down care facilities should also include not only those for physical illnesses but also for mental illnesses and dementia. May I ask the Minister if such facilities are adequately available for now and for future planning? This is important to avoid over dependence of expensive hospital care. Is there any better method on the postulations on healthcare needs here? For instance, is there consideration for the increasing life expectancy of the populace? Also, how much healthcare will those above 90 and 100 years of age need; we presently have 10,000 and 1,000 of them respectively? Three, homecare translates into convenience and much lower costs for many and, hence, a happier situation for our people. Homecare provision will enable patients to be cared for in their own homes for as long as possible and will thus lessen reliance on acute hospital care or other community hospital care.”
“Mdm Chair, may I ask the Minister to comment on our road congestion problem here, especially now with the rolling out of 1,400 buses by 2017?”
“There should be a team to take Page: 41 charge of these tasks on a long-term basis to study and predict the disruptions that may take place, either from past experience or from studies of similar happenings encountered by similar rail systems elsewhere. Public transport operators should be mandated to provide this preventive component from the beginning. Instead of just punishing PTOs for breakdowns, we should incentivise them to invest in preventive measures. I feel this approach will enhance reliability. On bus transportation, may I ask the Minister what has been the progress on the Bus Service Enhancement Programme? Is there still a shortage of bus drivers? Are the new buses put to maximum utilisation? How will the Minister further improve on service standards? May I ask the Minister whether he will review bus routes to provide more efficient and reliable options? Should long routes be shortened in order to increase reliability? Will the Minister also provide timetable bus services that take more than 10 to 15 minutes for buses to arrive at any one place in order to enable commuters to plan for their journeys better? 1.15 pm Train Service Quality”
“Mdm Chair, public transport reliability is a crucial factor in our effort to promote public transport as the mode of choice transport for the majority. Commuters expect high frequency, reliability and punctuality attached to rail travel. But we have failed in meeting their expectations. Last year, more than 130,000 commuters were affected by disruptions lasting more than an hour each, much the same number as in 2012, although these were less than in 2011. Such disruptions cause angst and anxiety, let alone the substantial loss in economic impact. Would MOT improve further and make an even better effort in curbing disruptions to our rail travel as soon as possible and adopt a zero-tolerance for major rail disruptions of more 30 minutes. Breakdowns on the 125-year-old 340-km 24-hour New York City Subway averaged one every 266,000 km compared to Singapore's 25-year-old 180-km network breakdown of once every 120,000 km. Could the Minister give an explanation for this stark difference? Is there anything that we can emulate? The Minister said in this House last month that Singapore's MRT system is more reliable nowadays and I quote, "We have made some strides in the right direction. But there is certainly room for improvement." May I then ask the Minister what measures are there in place presently to solve or achieve better reliability? Are these measures sufficient and sustainable in the long run? Will the Minister consider prioritising preventive measures to predict and prevent breakdowns before they occur, as mentioned by Mr Seng Han Thong before me? This is particularly useful for older rail systems. The purpose is to prevent disruptions by correcting faults before complete breakdowns or major disruptions happen.”
“There should be the provision of self-report questionnaires, instructions and activities in the school curriculum to enable bullying to be addressed amongst students, formation of discussion groups involving parents, empowerment through Student Anti-Bullying Committees and Peer Support programmes. Students should be encouraged and made easy for them to report on themselves or their friends being bullied. In view of the increased cases of cyberbullying, what are the measures in place to deal with this area with greater urgency? Can there also be better counselling services and pastoral care for all students involved or afflicted by school bullying? Harnessing the Energy of Parents”
“Madam, bullying in schools can occur in any setting and takes many forms. It occurs in schools without exception, regardless of socio-economic or cultural background. The various types are verbal, physical, racial and cyberbullying. Although, in Singapore, verbal bullying is most common, the two emerging forms of bullying are cyberbullying and racial motivated bullying. Bullying has clear, deleterious impacts on both the victim and the bully. Numerous studies on the subject have noted a positive correlation between being bullied and an increased risk of depression, anxiety, low self-esteem and even suicide. Bullying also has a negative effect on the bully, including increased estrangement from the rest of the school and/or society and contributes to an increased risk of the bully being engaged in criminal activity and youth delinquency and higher tendency to enter into crime as adults. May I ask MOE if there is any study done to ascertain the prevalence of school bullying in our schools. MOE treats bullying as a "disciplinary problem" which is far too general in my view. Can MOE adopt a tough no-tolerance policy on bullying in our schools like the UK and Australia? MOE should implement Page: 10 model bullying policies to be adopted by all schools and defining the prohibited actions or behaviours so that there is consistency in all schools. Could MOE adequately train all teachers to better detect and to deal with bullying? Could MOE raise the awareness on the prevention of school bullying among students, parents and schools.”
“Mdm Speaker, I am glad that MOT accepts the FRMC's recommendations to give fare concessions to low-income workers, the disabled and Polytechnic students. May I ask the Minister whether the fare concessions can be given as Monthly Concession Passes, especially for the needy and the elderly, instead of the usual one-off transport vouchers? May I ask the Minister how does his Ministry ensure good outreach to assist the targeted groups so that no one falls through the cracks? Lastly, will the Minister consider different fare pricing for Singaporeans, PRs and visitors for our public transport?”
“Their tuition classes are conducted free-of-charge by tertiary students of NUS and Singapore Polytechnic. Local parents in financial difficulty that assist in this centre get allowances to support their families. The grassroots volunteers take turns to take the children out for outings and outdoor sports. I hope that MSF will facilitate the setting up more of such avenues towards building social support networks for families and children, where communities can come together to contribute and make a difference for the better in the lives of others. Madam, I would like to end by quoting what the Prime Minister said at the National Day Rally, "Today, the situation has changed. If we rely too heavily on the individual, their efforts alone will not be enough, especially among the vulnerable, like the lower-income families, like the elderly. There are some things which individuals cannot do on their own, and there are some things which we can do much better together. So, we must shift the balance, the community and the Government will have to do more to support individuals". Thank you, Prime Minister, for saying that. Thus, let me entreat this House to take this initiative today to intervene early and assist the vulnerable children and ensure that they do not fall into the perpetuating cycles of deprivation. Let the children have a good start in life. Help them to level up and to achieve a better future. [Applause] 4.15 pm”
“Those who have not learnt to control their aggressive reactions by the time they enter the school system enter a vicious cycle of negative interactions, where rejection from their peers, because of their aggressive behaviour, leads to more aggression. Thus, with a policy for collaboration and communication between Ministries in place, early intervention and follow-up of such children will be possible with better outcomes. The Scandinavian countries consistently lead international comparisons in terms of child welfare and general well-being. Recognising the value of prevention and early intervention programmes, in the last 20-30 years, these countries have increased investment in such channels. International research suggests that the most successful programmes tend to share common characteristics: they target specific populations; they are intensive, they focus on behaviour, they include both parents and children and Page: 75 they stay faithful to their programmes. Community volunteers. Volunteers from the community are an invaluable resource that should be tapped. I would like to illustrate an example in my constituency which is set up by my grassroots volunteers and completely run by generous donors and volunteers from the community. It is called CATCH, which stands for Children And Teens Community Hub. This centre is situated at Jalan Kukoh RC. This centre has more than 100 participating members ranging from age six to 16 years from nine blocks of HDB rental flats. Sponsored full-time staff supervise these children daily. CATCH members can come daily to this centre for their tuition, school-work supervision, computer classes, games and indoor activities. These children get free meals and snacks daily, sponsored by food catering companies.”
“Such parents Page: 74 need convincing that they can bring real and lasting benefits to their children. Our Government, Mdm Speaker, firmly believes that every child should have the chance to succeed, regardless of his or her background. Deputy Prime Minister Tharman Shamugaratnam had said that more must be done to level opportunities for young children in Singapore. He said, and I quote, "intervene early, intervene upstream, not downstream". Inter-Ministry collaboration. In recognising the value of prevention and early interventional benefits, I now beseech our Government for the creation and provision of inter-Ministry collaboration and communication, with the clarity of purpose and the determination to make improvements for families in need over the immediate and long term. The relevant Ministries are: MSF for welfare, childcare and parenting programme, MOE for educational needs and after-school care, MND for housing needs, MOM for job upgrading and matching and MHA for the well-being of adolescent children. According to an MHA report, there were 1,535 juveniles arrested in Singapore in 2012. MHA believes in early intervention to seek and to identify pre-delinquents or youths in order to correct their behavioural or criminal tendencies before delinquency results. In four decades of research into the origins of violent behaviour, Prof Richard Tremblay of the University of Montreal has found solid evidence that the most aggressive and violent adolescents did not become more violent in their adolescent years. They were already very violent at age six and had much higher levels of violence than other children of the same age at age three.”
“These families can benefit from better social skills, self-efficacy and self-confidence. The assigned social workers for these families will need to collaborate with different agencies to provide the correct solutions. Whilst our Government has always emphasised the virtue of self-reliance, exceptions have to be considered for those families who need that extra help and funding from the Government. The purpose in assisting such families is to achieve a more conducive environment for their children. This will ensure healthier subsequent stages of their children's development. These families will need continued follow-up unless there is a change for the better in the home environment. This may mean following these families for their children to go through from their Primary 1 education to their Secondary school education. A specifically assigned social worker for such children will ensure familiarity and continuum of family service. The link between reducing child impoverishment and parental employment is strong. In UK, a survey had shown that the risk of relative impoverishment for a child in a workless household is 53%. This falls to 7% for households in which all adults work. May I suggest that our Government enable better opportunities for the parents of these families to increase their skills level? This can help them progress to sustainable employment. Some of them may have complex needs, especially non-working mothers who are furthest away from the labour market. They need a hands-on approach by social workers in meeting their needs and in pre-employment training. These may include improving literacy and numeracy skills and confidence building. Poverty alone is not a block to good parenting but low levels of literacy, numeracy and confidence are.”
“In UK, it was found that high-quality early education is crucial to making a difference in achievements of children, especially those from disadvantaged backgrounds, since an overwhelming majority of children who had a good level of development in the foundation years go on to achieve well in later stages of learning. Intervening earlier with troubled families not only prevents children and their parents from falling into cycles of deprivation, anti-social behaviour and poverty but also saves thousands, if not, millions in the longer term. In fact, studies of early childhood education programmes typically find that disadvantaged children benefit much more from these interventions than do non-poor children. Our Government sees the importance of early childhood education and has amended and improved this sector recently. I feel that it is very crucial that the Page: 73 disadvantaged children get the proposed high-quality childcare and pre-school education as well as the subsequent after-school care. Thus, vulnerable children should be given subsidised pre-school education and, furthermore, a certain number of such pre-school education places should be reserved for them. Parenting programmes. Parents have the most significant influence on children, and parenting has profound consequences for their children's lives in the future. Training in parenting skills should be facilitated for vulnerable families in order to improve the well-being and behaviour of their children. Some families in difficulty may need personalised assistance in psychological counselling for stress and depression, medical care, difficulty with their children's behaviour, strained relationships and financial assistance.”
“Targeting parental risk factors, as well as child outcomes, reduces the risk of problems being passed on to children as they grow up. We need to provide guidance and support to the parents for better home environments. Some of these families may need extra assistance, such as domestic violence, anger control, drug abuse, alcohol problem, medical care and divorces, all of which increase the risk of poor children outcomes. The problems experienced by some children and families may respond to a single intervention, others will require longer-term support and some may also be complex. It is, therefore, crucial that a continuum of support and communication can be provided and with the resources to meet the specific needs at a particular time. I hope that such provisions can be created and sustained with the implementation of the right policy. Early intervention. According to Nobel Prize-winning economist Prof James Heckman of The University of Chicago, early interventions "promote schooling, raise the quality of the workforce, enhance the productivity of schools and reduce crime, teenage pregnancy and welfare dependency". Recent research in neuroscience, developmental psychology, economics and other fields suggest that the earliest years of life may be a particularly promising time to intervene in the lives of low-income children. Mdm Speaker, special attention and assistance given in the first few years of children's lives lead to better economic, social and emotional benefits later on for both individuals and for society as a whole.”
“A child's physical, social and cognitive development during his/her early years strongly influences his or her school-readiness and educational attainment, economic participation and health. Evidence has shown that development of early cognitive ability is strongly associated with educational success, higher income and better health later in life. The early years are also important for the development of non-cognitive skills, such as application, self-regulation, resilience and empathy. These are the emotional and social capabilities that enable children to make and sustain positive relationships and succeed both in school and in later life. High-quality provision at this age has a long lasting impact on a child's chances. Key research findings strongly indicated that outreach is an essential factor in ensuring that intervention and support can be targeted at the most vulnerable families in the community. Family support can be informal or therapeutic, reactive when parents are struggling or anticipatory in order to prevent problems from arising in the first place. May I suggest that we identify the lowest income families and the children that can potentially be disadvantaged from as early as at the time of birth registration? This would pre-empt our losing track of these children and only meeting them at Primary 1, which is the current status for far too many children. The aim is to follow up on such families with specially assigned social workers and to offer assistance to those who have less than favourable home environments. These families receive more individualised support in a holistic Page: 72 way so as to spot and to tackle emerging difficulties.”
“Disparities between poor and non-poor children exist from as early as Primary 1. Ideally, children should not suffer from the unfortunate circumstances into which they are born. They ought to be given special attention and given extra assistance so that they can get the opportunity to break free from being disadvantaged and from remaining in their poverty trap. I would entreat this House, Mdm Speaker, to set up targeted and encompassing interventions for the disadvantaged children mainly from the lowest income families. Let us implement effective and evidence-based Page: 71 interventions early so that families receive the appropriate assistance as early as possible. The three approaches we should adopt are: (1) targeted family support and outreach; (2) early intervention; and (3) parenting programmes. Targeted family support and outreach. I would like to suggest that we identify and intervene very early on the families that need special attention. The purpose is to assist young disadvantaged children who do not have the same level of support or are unable to benefit from the same opportunities as others. Targeted interventions should be designed and used to identify problems early and prevent them from recurring. There should be a range of interventions that is able to provide support for differing and varying types of needs of families. Family support encompasses a range of assistance with the purpose of strengthening families and promoting the well-being of their children. Families needing this kind of support include those with single mothers, unemployed fathers, families in poverty, broken families without adequate housing, disabled children and those with special educational needs.”
“Mdm Speaker, I would like to suggest that this House implement measures to ensure that disadvantaged children, many of whom are from the lowest-income families, receive the assistance they badly need to break free from their predicament and to let our society become stronger and fairer. John, not his real name, is a 10-year-old Chinese boy who lives in my HDB rental estate. He was born to a single mother and has been cared for by a guardian, his mother's male friend, since he was four. John's mother is and has been in jail for the past six years. John is very much alone; wandering around by himself in the neighbourhood, playing truant from school often and doing poorly in his studies. Ahmad, not his real name, is a 5-year-old boy who has never attended childcare or pre-school education. He can only respond in his mother tongue and he does not even know the English alphabets. Ahmad has four other younger siblings from one to four years old. For a long time, Madam, we have adopted the policy that the best way to help our disadvantaged children from lower-income families is to assist them to attain academic achievement in order to climb the social mobility ladder in due course. The same policy also emphasises the motivation for families to encourage hard work and self-help. I have mentioned earlier only two examples of how children may still be disadvantaged today. The problem here, really, is the social predicaments these children are facing with regard to home environment, peer and neighbourhood influences, as well as parental guidance that have disabled them from benefiting fully from our education system. It appears that children living in poverty benefit less than non-poor children in spite of the same exposure to our education system.”
“Mdm Chair, two clarifications, please. May I ask the Minister whether he will set up a system, in place with resources, to assist disadvantaged children in a more holistic way and adopt a hands-on approach in order to give this group a chance in social mobility? My second clarification is on what he said earlier. He said that the Public Assistance (PA) cases do not need to come forward to seek for extra assistance because they are visited regularly, and he added that, in fact, it should be so because they will not know the new financial assistance scheme. May I ask the Minister who Page: 61 are these people that he referred to, who pay visits to our 3,000 cases of PA presently, and how often are these visits made?”
“Page: 174 Living Wage and Public Assistance Schemes”
“Are there plans to build respite centres enabling day-care for those with mobility difficulties and community rehabilitative centres for those who are discharged from the community homes needing some rehabilitation supervision. I applaud MSF for the new enhancements in the PA scheme this month. The monthly increment of $50 will address the higher cost of living. The second tier and third tier assistance are most welcomed. The discretionary assistance is timely and far-sighted in view of our ageing population. We can expect more elderly living longer and therefore more of them having medical conditions. This discretionary assistance will enable many more to stay in their own homes, with assisted living equipment, for as long as possible despite their medical conditions. The policy for the PA scheme enhancements was well thought out to reach the recipients who have many variable needs. It is a not the usual one-size-fits-all kind of policy as rightly it should be. I hope many more of our new policies can be similarly designed to better target the end users. My concern is how is the Minister ensuring that the PA recipients get to receive the new secondary and discretionary assistance? Many of them will not be well informed or know how to go about them. Since many of the criteria are related to healthcare daily consumables and medical equipment, could MSF cooperate and synergise better with MOH about the recipients to channel the types of daily medical needs and the medical equipment to fix in their homes readily and seamlessly. This will help reduce the dependence on institutional care and is good for both MOH and MSF. May I ask the Minister whether he will also review other assistance schemes under MSF, the Hope scheme for instance, to have new enhancements as well?”
“Could such families be offered job-upgrading opportunities to meet the needs of their children? I beseech MSF to assist children from these lowest income families. Help in this area is still deficient and we need special intervention and more resources to improve their predicament. Let us give them a better start in life and a better chance for social mobility. These children and their families need assistance through personal guidance and in a hands-on approach. Daily supervision of these children with their school-work, basic necessities, activities and hobbies can be provided for them after school. It will be ideal to have centres in the community near their homes and have them cared for by committed staff. Social workers can assist such families with the intention of helping them achieve more conducive home environment. May I ask the Minister on the availability of social workers and will a shortage of them be Page: 173 relieved anytime soon? As the number of elderly in our population is increasing, may I ask the Minister to consider providing facilities or centres that enable healthy community living? Such facilities will enable the elderly to live independently and healthily in the community for as long as possible. Such facilities would also allow the elderly themselves to bond and care for each other. This is useful especially when one of their buddies should become frail. The idea of self-help is an untapped extra resource in the community. There should, of course, be support from voluntary group organisations and grassroots organisations for such facilities as well. Will the Ministry set up more Senior Activity Centres?”
“Mr Chairman, there is a pressing shortage of childcare and infant-care centres now. In order to get more housewives to join our tight labour market, this shortage needs urgent fixing. For young couples, the availability of good childcare and infant-care centres is an important factor in their considerations about starting to have children. Many families need to have the dual incomes and many young career women do not want to give up their career advancement opportunities. Availability of good childcare facilities is, therefore, crucial toward better TFRs. While I understand there is a tremendous shortage for childcare staff, I hope MSF can help alleviate the situation as a matter of urgency. May I ask the Minister how short are we over the demand for childcare centres? How confident is the Minister on ensuring a sufficient supply of them and over what sort of timeline will the supply be met? Many parents have complained that private childcare centres are very expensive. Some have lamented that fees charged by privately-run centres got even higher in spite of the increment of Government childcare subsidy. May I ask the Minister if he will consider regulating prices charged by privately-run childcare centres in lieu of Government subsidies? Many of the lowest income families are in chronic need of financial assistance because only one parent is earning. Very often that parent can only earn low wages and still need to support two or more children. There is a need to assist such families holistically on a more permanent basis. Will the Minister provide a special scheme targeted at assisting these families? Could assistance be given to pair the mothers in these families for jobs with childcare placement?”
“Thank you, Mdm Chair. May I ask the Minister how does MOE ensure that our disadvantaged children get the good preschool education they badly need? How does MOE identify these children, and then how does MOE guarantee preschool education places for this group? Lastly, will MOE also ensure that the school-based student care places are available for this group and are targeted at them? Page: 163”
“The parents that can provide adequately are the ones that usually apply for their children to be even better supervised. Could MOE systematically identify and help children from disadvantaged families to get such care? Could these children also be paired with social workers, who can then assess if they have parents that also need assistance in improving their home environment? In situations where student care is not available in the schools, could MOE collaborate with MSF to have these children placed at community student care centres near their homes? Uplifting Quality of Preschool Education”
“Madam, preschool education for our children has been less than ideal all these years. Preschools themselves vary vastly in quality from one to another. Preschool fees also differ greatly among them, ranging from $100 to $1,000. The children from the well-off families are the ones that usually get to attend the higher quality preschools. Preschools should not just equip our children with reading and numeracy skills in preparing for primary schools. Good preschool education emphasises the importance of early brain development in children. Some of these examples are social awareness, living environment awareness, group interaction skills, motor skills and overall confidence. I hope MOE will be able to embrace these attributes in its effort on improving the overall standard of preschool education and on providing more equivocal standards for all. I also hope MOE will place great importance on giving all our disadvantaged children the preschool education they badly need. This will enable them an early start and a better chance for social mobility. We need a system in place to identify these children for good preschool education. Perhaps the identification of these children should be made at time of birth where detailed social history is more easily obtainable. Student care centres are very beneficial for children from disadvantaged families as these children usually lack supervision in their less than conducive home environments. In view of our limited student care centres, especially the school-based ones, could MOE reserve these places for such children in these schools? More often than not, the parents of these children will not come forward to request for such places.”
“May I ask the Minister whether MOT is able to take back the existing rights from the present PTOs if MOT so wishes in the Page: 72 immediate term, so that MOT can revamp and have an improved new model for our public transport.”
“Commuters argue that the public transport operators are making healthy profits and should not require more revenue presently. Perception on the ground is that there is more weightage placed on the interest of shareholders by transport operators. How does MOT regulate operators to ensure that there is better provision and standard of services? Could MOT incentivise our public transport operators to increase their efficiency and productivity? It was announced last year that Changi Airport's Budget Terminal will be developed. Could the Minister provide an update on the status of the development, as well as some of the design features, of the new Terminal? Improving the Appeal of Public Transport”
“May I ask the Minister whether our public transport model needs a relook and is it not better to move away from the profit-orientated business model that is answerable to shareholder-interests, which may further add on to the cost of public transport here? What are the causes for the frequent breakdowns and unacceptable customer service standards? Are problems mainly due to natural wear and tear or due to profit considerations with cost-cutting measures? Are there any intrinsic engineering difficulties rather than operator incompetence that cause the frequent breakdowns? Were there enough considerations for aftercare maintenance, in terms of engineering and costs, made at the stage of formulation and implementation of our public transport infrastructure previously? And do we have a more concerted effort to ensure plans have sustainability and smooth operation of our public transport? Are there synergy Page: 145 and consultations amongst stakeholders concerned? I hope it is not a case of passing over and relinquishing all responsibilities from planner to operator once infrastructure is built. Is it better to have the same planner operating and maintaining the infrastructure subsequently? Will the Minister consider targeted subvention for certain sectors of the population, such as the retirees, students and the lower income? Rather than a blanket subvention for all, subvention in this manner will go to those that need it most. Will MOT at least consider giving more concessions to retirees and the long-overdue concession to polytechnic students? I hope that MOT will prevent any increase in our public transport fares until public transport service improvements take place.”
“I also hope that MOT can have better communications with residents and try not only to provide the relevant service enhancements, but also to better explain any planned Page: 144 improvements and to get the end-users' views and feedback. Also, residents should be acknowledged for their contributions, especially when enhancement services have resulted from such views and feedback. Bus and train ridership is on the increase, and it will be so with a growing population and the curbing of car ownership. My question is whether the planned service enhancements by MOT will be overtaken by this increase in the ridership in the immediate term as well as long term. Are the projections on the demands upon our public transport system sound? Is there a KPI set for ridership with ease and convenience? My own concern is that improvements may not be palpable by commuters in the near term. It is important and easier for people to foresee a better tomorrow and to work closely with the Government if there is something at hand to show and to grasp. Communication is key to explain the many pressing constraints that may have hindered faster progress of improvements and yet allow people to visualise that things will get better. The land here is small and finite. How does MOT plan to improve bus services with more roads while negotiating with other infrastructure needs, such as more housing? How will the extra 800 buses affect the traffic flow on our roads in the next few years? May I ask the Minister on the situation of taxi availability since LTA's measures to tackle the shortage, especially at peak hours? Will the new measures with more taxis on the road affect traffic flow in the near term?”
“The Land Transport Masterplan 2013 providing more connections and better services is laudable but will take a long time to materialise. There is great urgency to solve the congestion woes in the immediate term as commuters are greatly inconvenienced in the meantime. May I ask the Minister what plans are in place now to better solve the present congestion? Apart from causing public angst, our public transport system is a contributory factor against the productivity growth we aim for. Is MOT looking at all possible ways to have immediate relief for the congestion? Perhaps to incentivise change in behavioural patterns, by giving free public transport one hour before and after peak hours daily? The Bus Enhancement Programme 2012, with 780 weekly bus trips, has not made any impact upon commuters. Will the additional 800 new buses announced be able to make a difference? How soon will the new buses be operational? Can all the buses be rolled out sooner within the next few years? Could Minister consider other measures or enhancements in the interim to relieve the present congestion such that commuters can see and feel at least some improvement in bus and rail transport in the next few years? May I suggest that MOT gives priority and makes a targeted approach for the use of the new buses by getting better feedback in identifying the areas where the largest numbers of commuters are inconvenienced? As there is limited immediate resource available, it is best to target such areas that need improvement with the new buses or routes or feeder services.”
“Many cases of the psychiatric patients are being treated less well because when they are in the community, they have less follow-up. And sometimes, they just ignore taking their medications and they do not have good supervision and that is posing a harm to themselves and also causing inconvenience to their family members.”
“Mdm Chair, can I seek two clarifications from the Minister, please? On my first clarification, may I ask the Minister whether he will consider my earlier suggestion on reducing the out-of-pocket payments for patients, especially those from the lower-income group and the retirees? For example, will he consider a tiered reducing co-payment system? On my second clarification, may I ask the Minister whether he will make available better referral systems for psychiatric patients in the community and better care of such patients in the community? The reason is that presently, there are many neurotic cases and psychiatric cases in the community that are under-diagnosed and under-treated. So, could the Minister look into this?”
“In view of the increasing healthcare needs of an ageing population, there is an urgent need of planning task for MOH in the area of medical infrastructure, Page: 62 to cope adequately and in a timely manner. My concern on healthcare is the exponential increase in demand for nursing homes, community hospitals and acute hospitals. It is, thus, necessary to have good projections on demand, early planning and proactive measures in place. We also need to increase our healthcare personnel, nurses and doctors, especially geriatricians. Preventive healthcare has and should always be the hallmark of our healthcare system. It is ideal if we can keep our citizens healthy for as long as possible through prevention of chronic diseases. Let us spare no effort in promoting preventive healthcare. Can MOH, therefore, provide incentives for our people to eat healthily and exercise regularly? Obviating long-term care in institutional settings should remain the basis of eldercare. Step-down care facilities such as community hospitals, day-care centres and community-care centres must be adequately provided so as to reduce the overload on expensive hospitals beds. We need one new aspect of preventive healthcare in the community for the elderly. It is to facilitate the elderly to live as independently and for as long as possible in their own homes, with given support as in homecare and community support as with Seniors Activity Centres. Long-term Healthcare”
“Madam, our Healthcare 3M system, an envy of many countries, is supposed to adequately take care of the medical needs of our citizens. MediFund guarantees that no one is deprived of medical care due to the lack of funds. Why then are so many of our elderly still concerned about healthcare costs? It cannot be explained simply that they are less knowledgeable or less well-informed about the various available schemes. Otherwise, their concerns would have been resolved and not be perpetuated till today. My analysis is that their concern is not unfounded especially for those with the lowest incomes and for many retirees. This group often has little personal savings and MediSave accounts. Our system requires everyone to co-pay the initial amounts for any medical care. Although I personally believe in having some co-payment to prevent the buffet syndrome, I think we need a tier-system with reduced co-payments for the retirees and the lowest income Singaporeans. Even hospital outpatient treatment costs can be hefty out-of-pocket payments for this group; this is quite apart from co-payments for hospitalisation. It is time to tweak our medical financial framework in view of an ageing population with increasing smaller families. It is getting difficult for siblings of small and especially low-income families to share the healthcare burdens of parents. I believe in insurance risk pooling. It is definitely a necessary way forward. May I ask the Minister whether he can further strengthen this insurance framework? Are there too many retirees or low-income families who cannot afford to join MediShield? Is it not better to assist them to join MediShield rather than to face costlier payments in the end when they need hospitalisation?”
“It is a worthwhile and important pursuit for a better tomorrow. It is building a strong social infrastructure for our country. I would like to suggest that we form a new Cohesion Ministry in order to ensure sufficient emphasis, continuity and outcome. Denmark has a "Ministry of Social Affairs and Integration" for coordinating the government's efforts to promote civic citizenship and integration. I hope our Government will set up a similar Ministry to ensure cohesion, national identity and integration for a stronger Singapore. Mdm Speaker, the other bedrock of a cohesive society is the provision for the less well-off group of our society. I am glad that this Budget has provided much for their needs in many areas. Page: 20 I applaud Deputy Prime Minister Tharman Shanmugaratnam on what he said, and I quote, "We also want to do more to enable our seniors to have a sense of economic security and fulfilment in their retirement years." With our impending demographic changes of a growing number of elderly populations, the number of the elderly poor will increase in the future. May I beseech our Government to have another safety net for this group to give them peace of mind as they grow old? I would like to suggest having an "Elderly Endowment Fund" to ensure that no elderly Singaporean will be deprived of their daily living due to the lack of means, similar to the Medifund that ensures that no Singaporean will be deprived of medical care due to the lack of funds. On this note, Mdm Speaker, I support the Motion. 12.36 pm”
“My fear is that the rhetoric of future Singapore Core being "only those born and bred here" may resonate with some people and may fester into more support of such suggestion in the community. Such views amongst political parties here may invariably promote discord amongst the citizenry. It is crucial that our Government ensure that discord among political parties here does not spill into discord on the ground. That said, I believe that policies are made for the benefit of Singapore and Singaporeans and the granting of permanent residence and citizenship is discerning enough to ensure positive contributions and not otherwise from the newcomers. The interest of Singaporeans must come first in any formulation of policies and, more importantly, the policies must ensure that we do not attract people with wrong motives. I would argue for a relook at our policies and tweak them so that immigrants welcomed to our shores cannot take undue advantage of our goodwill and be detrimental to Singaporeans. One such relook would be on the criteria for PRs to own homes in Singapore. There had been laments that PRs have bought HDB properties here at subsidised prices, though lesser than Singaporeans, and landed homes, which other foreigners are not eligible, only to sell them at great profits several years later and leave Singapore with their windfall. Should we not offer such benefits only to those who really intend to make Singapore their permanent homes, and thus incentivising only those who want to sink roots here? Lastly, Mdm Speaker, the three areas of consensus, forging unity and assimilation of new Singaporeans need a lot of continuous efforts in planning and execution. They therefore require a lot of commitment and resources to ensure results.”
“I feel that our Government should invest in this pillar that promotes a cohesive society. This cannot be ad hoc efforts, and we need continuous action plans that set out policies backed up with adequate resources. Three, assimilation of new Singaporeans. Singapore is now taking in about 20,000 new citizens each year. This intake is necessary to stop our citizen population from shrinking. There is a need to better integrate our new citizens into our Singapore society. It really takes two hands to clap and we must have a conscious effort from both the new immigrants as well as locals to make this work. Our Government can play a vital role in this area and, for a start, our Government must send the right signals to all concerned. It is necessary to prevent any discord among new citizens and Singaporeans, and for that matter, any discord between Singaporeans. This is so vital for our multiracial society. The unity among Singaporeans, be it the inherent or the new citizens, must be the basis of the "Singapore Spirit" and the common vision of togetherness. I have been fortunate that I was included in the Singapore Core, although I was not born and bred here. The truth is that I grew up and stayed in four different countries before settling down in Singapore. I made Singapore my home, raised my family here and my son has done National Service like any other Singaporean. I am wholly committed to Singapore and will do the best I can to contribute like any other Singapore Citizen. Thus, I hope that more people like Page: 19 me will come and make Singapore their home just like what I have done, but more importantly, that they can be truly included in the Singapore Core.”